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Son TN, Mai DV, Tung PT, Liem NT. Laparoscopic versus open Kasai procedure for biliary atresia: long-term results of a randomized clinical trial. Pediatr Surg Int 2023; 39:111. [PMID: 36763200 DOI: 10.1007/s00383-023-05391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE The role of the laparoscopic approach for the Kasai procedure in the management of biliary atresia is still controversial. The aim of this study is to compare the long-term results of the laparoscopic Kasai procedure (LKP) to the open Kasai procedure (OKP). METHODS A randomized clinical trial was carried out from October 2009 to March 2017. Patients diagnosed with biliary atresia type III were randomized into 2 groups: one group underwent LKP and the other group-OKP. All the surgical procedures were performed by the same surgeon with the same technical principles. The long-term outcomes were compared between the two groups. RESULTS 61 patients underwent LKP and 61 patients-OKP, with a median age at the surgery of 79.7 days. The two groups had no significant differences regarding the patients' baseline characteristics. At follow-up up to 142 months, the jaundice-free rate at the 6th postoperative month for LKP and OKP was 52.5% and 60.7%, respectively (p = 0.23). The 10-year cumulative survival after LKP tended to be inferior to OKP, respectively 44.3% vs. 58.9% (p = 0.09). CONCLUSIONS In this study, the long-term results of LKP tended to be inferior compared to OKP although the differences were not significant.
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Affiliation(s)
- Tran N Son
- Department of Pediatric Surgery, Saint Paul Hospital, No 12 Chu Van An Street, Ba Dinh District, Hanoi, 100000, Vietnam.
- Department of Surgery, National Children Hospital, Hanoi, Vietnam.
| | - Duong V Mai
- Department of Pediatric Surgery, Saint Paul Hospital, No 12 Chu Van An Street, Ba Dinh District, Hanoi, 100000, Vietnam
| | - Pham T Tung
- Department of Surgery, National Children Hospital, Hanoi, Vietnam
| | - Nguyen T Liem
- Department of Surgery, National Children Hospital, Hanoi, Vietnam
- Vinmec International Hospital, Hanoi, Vietnam
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Li B, Chen WB, Xia SL. A Comparison of Laparoscopic-Modified Kasai Versus Conventional Open Kasai for Biliary Atresia in Infants: A Single-Center Experience. J Laparoendosc Adv Surg Tech A 2023; 33:226-230. [PMID: 36270014 DOI: 10.1089/lap.2022.0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: The purpose of this study was to evaluate the efficacy of our modified laparoscopic Kasai portoenterostomy for type III biliary atresia (BA) in children. Methods: A total of 56 type III BA patients underwent laparoscopic-modified Kasai procedure from January 2015 to July 2021. Conventionally control group of 45 BA patients from January 2012 to January 2016 were operated by open Kasai. The clinical data between the two groups were retrospectively compared. Results: The mean operating time was 235.5 ± 20.5 minutes (range, 210-275 minutes) in Group I, whereas 180.5 ± 25.5 minutes (range, 155-210 minutes) in Group II. The oral intake resumption was faster in Group I than that in Group II (mean 3.5 days versus 4.5 days). The follow-up time was mean 18.5 months in Group I and 24 months in Group II. The clearance of jaundice (total bilirubin <20 μmol/L) was significant different in Group I (78.6%) (44/56) versus that of Group II (74.3%) (33/45). The native liver survival rate was 71.4% (40/56) in Group I and was 66.7% (30/45) in Group II at the follow-up time, respectively. Conclusion: The laparoscopic-modified Kasai would improve the outcome of BA patients.
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Affiliation(s)
- Bing Li
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, P.R. China
| | - Wei-Bing Chen
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, P.R. China
| | - Shun-Lin Xia
- Department of Pediatric Surgery, Huai'an Women and Children's Hospital, Huai'an, P.R. China
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Zhang M, Cao G, Li X, Zhang X, Li Y, Chi S, Rong L, Tang ST. Robotic-assisted Kasai portoenterostomy for biliary atresia. Surg Endosc 2023; 37:3540-3547. [PMID: 36602550 DOI: 10.1007/s00464-022-09855-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Robotic-assisted Kasai portoenterostomy (RAKPE) has been utilized to treat biliary atresia (BA). However, RAKPE is not widely performed and its efficacy remains unknown. We summarized the experience of RAKPE for BA and determined its efficacy. MATERIALS AND METHODS We retrospectively analyzed 25 consecutive infants with non-syndromic type III BA who received RAKPE in our center from January 2020 to July 2021. RAKPE is a three-arm setup and four-trocar operation. Bipolar coagulation was used to dissect the small blood vessels at the hepatic portal. The fibrous cone was shallowly transected with bending electric scissors, followed by gelatin sponge compression to staunch the hemorrhage. Finally, a wide anastomosis was accurately constructed. Demographics and outcomes were recorded. RESULTS The mean operative time was 211.64 ± 18.93 min. No conversion to laparotomy or intraoperative complications occurred. The mean estimated blood loss was 7.64 ± 2.43 mL. Enteral feeding was resumed after 3.44 ± 1.23 days. All patients achieved bile excretion postoperatively, and dark green bile-stained stools were passed 1.50 days (range 1.00-3.00 days) after surgery. The average postoperative length of hospital stay was 10.32 ± 2.59 days. The jaundice clearance (JC) rate was 76.00% within 6 months after surgery and the incidence of cholangitis was 48.00% within 1 year following surgery. The survival with native liver (SNL) rate was 80.00% at 1 year and 66.67% at 2 years. CONCLUSION RAKPE can be regarded as a treatment option for patients with BA due to the good outcomes reported. However, long-term studies comparing open or laparoscopic approaches are needed.
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Affiliation(s)
- Mengxin Zhang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Guoqing Cao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Xiangyang Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Xi Zhang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Yibo Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Shuiqing Chi
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Liying Rong
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Shao-Tao Tang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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Abstract
This article discusses current standard of care in neonatal biliary disease, particularly management of biliary atresia and choledochal cysts. It highlights surgical considerations, guidelines for adjuvant therapies, and promising therapeutic options that are under investigation.
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Affiliation(s)
- Sarah Mohamedaly
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, HSW 1652, Campus Box 0570, San Francisco, CA 94143-0570, USA
| | - Amar Nijagal
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, HSW 1652, Campus Box 0570, San Francisco, CA 94143-0570, USA; The Liver Center, University of California, San Francisco, CA, USA; The Pediatric Liver Center at UCSF Benioff Childrens' Hospitals, San Francisco, CA, USA.
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5
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Jahangirnia A, Oltean I, Nasr Y, Islam N, Weir A, de Nanassy J, Nasr A, El Demellawy D. Peri-Operative Liver Fibrosis and Native Liver Survival in Pediatric Patients with Biliary Atresia: A Systematic Review and Meta-Analysis. Pediatr Gastroenterol Hepatol Nutr 2022; 25:353-375. [PMID: 36148293 PMCID: PMC9482824 DOI: 10.5223/pghn.2022.25.5.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/13/2022] [Accepted: 07/14/2022] [Indexed: 11/29/2022] Open
Abstract
No systematic review to date has examined histopathological parameters in relation to native liver survival in children who undergo the Kasai operation for biliary atresia (BA). A systematic review and meta-analysis is presented, comparing the frequency of native liver survival in peri-operative severe vs. non-severe liver fibrosis cases, in addition to other reported histopathology parameters. Records were sourced from MEDLINE, Embase, and CENTRAL databases. Studies followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and compared native liver survival frequencies in pediatric patients with evidence of severe vs. non-severe liver fibrosis, bile duct proliferation, cholestasis, lobular inflammation, portal inflammation, and giant cell transformation on peri-operative biopsies. The primary outcome was the frequency of native liver survival. A random effects meta-analysis was used. Twenty-eight observational studies were included, 1,171 pediatric patients with BA of whom 631 survived with their native liver. Lower odds of native liver survival in the severe liver fibrosis vs. non-severe liver fibrosis groups were reported (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.08-0.33; I2 =46%). No difference in the odds of native liver survival in the severe bile duct destruction vs. non-severe bile duct destruction groups were reported (OR, 0.17; 95% CI, 0.00-63.63; I2 =96%). Lower odds of native liver survival were documented in the severe cholestasis vs. non-severe cholestasis (OR, 0.10; 95% CI, 0.01-0.73; I2 =80%) and severe lobular inflammation vs. non-severe lobular inflammation groups (OR, 0.02; 95% CI, 0.00-0.62; I2 =69%). There was no difference in the odds of native liver survival in the severe portal inflammation vs. non-severe portal inflammation groups (OR, 0.03; 95% CI, 0.00-3.22; I2 =86%) or between the severe giant cell transformation vs. non-severe giant cell transformation groups (OR, 0.15; 95% CI, 0.00-175.21; I2 =94%). The meta-analysis loosely suggests that the presence of severe liver fibrosis, cholestasis, and lobular inflammation are associated with lower odds of native liver survival in pediatric patients after Kasai.
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Affiliation(s)
| | - Irina Oltean
- Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Youssef Nasr
- Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Nayaar Islam
- Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Arielle Weir
- Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Joseph de Nanassy
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Ahmed Nasr
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Dina El Demellawy
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Hinojosa-Gonzalez DE, Roblesgil-Medrano A, Villarreal-Espinoza JB, Tellez-Garcia E, Bueno-Gutierrez LC, Rodriguez-Barreda JR, Flores-Villalba E, Figueroa-Sanchez JA. Response to: Letter to the Editor, Minimally Invasive versus Open Surgery for Spinal Metastasis: A Systematic Review and Meta-Analysis. Asian Spine J 2021; 15:710-712. [PMID: 34706406 PMCID: PMC8561151 DOI: 10.31616/asj.2021.0395.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
| | | | | | - Eduardo Tellez-Garcia
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | | | | | | | - Jose Antonio Figueroa-Sanchez
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico.,Departamento de Neurología y Neurocirugía, Hospital Zambrano Hellion, San Pedro Garza Garcia, Mexico
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7
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Parolini F, Boroni G, Betalli P, Cheli M, Pinelli D, Colledan M, Alberti D. Extended Adhesion-Sparing Liver Eversion during Kasai Portoenterostomy for Infants with Biliary Atresia. CHILDREN-BASEL 2021; 8:children8090820. [PMID: 34572252 PMCID: PMC8470555 DOI: 10.3390/children8090820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Abstract
Background: Despite the fact that Kasai portoenterostomy (KPE) is the primary treatment for biliary atresia (BA), liver transplantation (LT) remains the ultimate surgery for two-thirds of these patients. Their true survival rate with the native liver reflects the original KPE and the burden of post-operative complications. We report an original modification of the adhesion-sparing liver eversion (ASLE) technique during KPE that facilitates the total native hepatectomy at time of transplantation. Methods: All consecutive patients with BA who underwent KPE at our department and subsequent LT at Paediatric Liver Transplant Centre at Papa Giovanni XXIII Hospital between 2010–2018 were retrospectively enrolled. All patients underwent ASLE during KPE. Patients’ demographic data, type of KPE, total transplant time (TTT), hepatectomy time (HT), intra-operative packed red blood cells and plasma transfusions, intra- and post-operative complications were noted. Results: 44 patients were enrolled. Median TTT and HT were 337 and 57 min, respectively. The median volume of packed red blood cell transfusion was 95 mL. No patients presented bowel perforation during the procedure or in the short post-operative course. No mortality after LT was recorded. Conclusions: In addition to the well-known advantages of the standard liver eversion technique, ASLE reduces the formation of intra-abdominal adhesions, lowering significantly the risk of bowel perforation and bleeding when liver transplantation is performed for failure of KPE.
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Affiliation(s)
- Filippo Parolini
- Department of Paediatric Surgery, “Spedali Civili” Children’s Hospital, 25123 Brescia, Italy; (G.B.); (D.A.)
- Correspondence: ; Tel.: +39-0303996201; Fax: +39-0303996154
| | - Giovanni Boroni
- Department of Paediatric Surgery, “Spedali Civili” Children’s Hospital, 25123 Brescia, Italy; (G.B.); (D.A.)
| | - Pietro Betalli
- Department of Paediatric Surgery, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.B.); (M.C.)
| | - Maurizio Cheli
- Department of Paediatric Surgery, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.B.); (M.C.)
| | - Domenico Pinelli
- Department of Surgery III, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (D.P.); (M.C.)
| | - Michele Colledan
- Department of Surgery III, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (D.P.); (M.C.)
| | - Daniele Alberti
- Department of Paediatric Surgery, “Spedali Civili” Children’s Hospital, 25123 Brescia, Italy; (G.B.); (D.A.)
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
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