title: Does pneumoperitoneum adversely affect growth, development and liver function in biliary atresia patients after laparoscopic portoenterostomy?
abstract: OBJECTIVE
  We assessed the effect of high partial pressure of arterial carbon dioxide (PaCO2) due to pneumoperitoneum (PP) on growth (height/weight) and development (gross/fine motor function, receptive/expressive communication, and social interaction), by comparing outcome after portoenterostomy (PE) for biliary atresia (BA) using laparoscopic PE (LPE: n = 13) and open PE (OPE: n = 13) cases performed between 2005 and 2014.
  
  
  METHODS
  Our PE is based on Kasai's original PE. All data were collated prospectively.
  
  
  RESULTS
  Differences in duration of follow-up (LPE: 38.8 months; OPE: 38.1 months), jaundice clearance (LPE: 12/13 = 92.3 %; OPE: 9/13 = 69.2 %), survival with the native liver (LPE: 10/13 = 76.9 %; OPE: 9/13 = 69.2 %), incidence of cholangitis, hypersplenism, and incidence of esophageal varices were not significant. Mean intraoperative PaCO2 was significantly higher in LPE (LPE: 50.1 mmHg; OPE: 40.7 mmHg, p < 0.05). Liver function impairment was not statistically different, although LPE results were slightly worse. There was no overall delay in growth observed, although height/weight gain was more consistent in LPE. The pattern of developmental delay observed was similar for LPE and OPE suggesting that developmental delay is not PE-related; in other words, PP is not implicated in developmental delay.
  
  
  CONCLUSIONS
  PP during LPE would appear to have no adverse effects on overall growth/development and liver function in BA patients.
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koga
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Okazaki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Urao
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.forename: Manabu
authors.initials: M
authors.lastname: Okawada
authors.forename: Takashi
authors.initials: T
authors.lastname: Doi
authors.forename: Hiroko
authors.initials: H
authors.lastname: Watayo
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ogasawara
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D001656:Biliary Atresia / Q000601:surgery*; D002657:Child Development; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D008111:Liver Function Tests; D008297:Male; D011027:Pneumoperitoneum; D011171:Portoenterostomy, Hepatic / Q000379:methods*; D011446:Prospective Studies