From laparoscopic to open Kasai portoenterostomy: the outcome after reintroduction of open Kasai portoenterostomy in infant with biliary atresia.
OBJECTIVE
Apparently superior result was observed after open Kasai portoenterostomy in infant with biliary atresia. Our institute stopped performing laparoscopic portoenterostomy since 2007. We aimed to investigate the outcome after reintroduction of open portoenterostomy.


METHODS
27 non-syndromic infants underwent open Kasai portoenterostomy from 2007 to 2012. The age and the sex of the patient, the bilirubin level before the operation, the early clearance of jaundice (total bilirubin <20 μmol/L within 6 month of portoenterostomy), the native liver survival at 2 years after the operation were reviewed. The results were retrospectively compared with all 16 infants who underwent laparoscopic Kasai portoenterostomy before 2007.


RESULTS
All infants had type III biliary atresia. No statistical difference was observed regarding the age at operation and the pre-operative bilirubin level. The early clearance of jaundice rate was 81% (22/27) after open operation and was 50% (8/16) after laparoscopic operation (p = 0.03). At 2 years after the operation, the native liver survival was 81% (22/27) after open operation and was 50% (8/16) after laparoscopic operation (p = 0.03).


CONCLUSIONS
Reintroduction of open Kasai portoenterostomy was associated with superior early clearance of jaundice rate and 2-year native liver survival rate.
Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China, edwinchan@surgery.cuhk.edu.hk.
Kin Wai E
KW
Chan
Kim Hung
KH
Lee
Hei Yi V
HY
Wong
Siu Yan B
SY
Tsui
Yuen Shan
YS
Wong
Kit Yi K
KY
Pang
Jennifer Wai Cheung
JW
Mou
Yuk Him
YH
Tam
D001656:Biliary Atresia / Q000601:surgery*; D001663:Bilirubin / Q000032:analysis; D015415:Biomarkers / Q000032:analysis; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome
D015415:Biomarkers; D001663:Bilirubin