Naruhiko Murase1, Akinari Hinoki1, Chiyoe Shirota1, Hirofumi Tomita2, Naoki Shimojima2, Hideyuki Sasaki3, Masaki Nio3, Kazunori Tahara4, Yutaka Kanamori4, Masato Shinkai5, Hirotoshi Yamamoto6, Yasuhiko Sugawara6, Taizo Hibi6, Tetsuya Ishimaru7, Hiroshi Kawashima7, Hiroyuki Koga8, Atsuyuki Yamataka8, Hiroo Uchida1. 1. Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 2. Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. 3. Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. 4. Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan. 5. Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan. 6. Department of Transplantation/Pediatric Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan. 7. Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan. 8. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: Multicenter study was undertaken to analyze the results of laparoscopic and open Kasai portoenterostomy. METHODS: Subjects were infants with type III biliary atresia who underwent open operation (n = 106) or laparoscopic operation (n = 21) between January 2012 and December 2015. Clinical data were compared between open and laparoscopic operations (2016-0534). Propensity score matching was performed to reduce the effect of treatment selection bias. Multivariate analyses were used to estimate the effect of the surgical approach on the jaundice clearance rate and the native liver survival rate. RESULTS: The postoperative jaundice clearance rate and the 1-year native liver survival rate were not significantly different between open and laparoscopic operations. Rates of cholangitis and major complications of laparoscopic operation were comparable to those of open operation. Blood loss, time to resume oral intake, time to drain removal, and duration of analgesic usage of laparoscopic operation were significantly superior to those of open operation. Similar results were observed when analysis was adjusted based on propensity score. Multivariate analyses demonstrated that only age at operation was a poor prognostic factor. CONCLUSION: Laparoscopic Kasai portoenterostomy was associated with several favorable perioperative outcomes compared with open Kasai portoenterostomy. The difference of surgical approach was not a significant independent predictor.
BACKGROUND: Multicenter study was undertaken to analyze the results of laparoscopic and open Kasai portoenterostomy. METHODS: Subjects were infants with type III biliary atresia who underwent open operation (n = 106) or laparoscopic operation (n = 21) between January 2012 and December 2015. Clinical data were compared between open and laparoscopic operations (2016-0534). Propensity score matching was performed to reduce the effect of treatment selection bias. Multivariate analyses were used to estimate the effect of the surgical approach on the jaundice clearance rate and the native liver survival rate. RESULTS: The postoperative jaundice clearance rate and the 1-year native liver survival rate were not significantly different between open and laparoscopic operations. Rates of cholangitis and major complications of laparoscopic operation were comparable to those of open operation. Blood loss, time to resume oral intake, time to drain removal, and duration of analgesic usage of laparoscopic operation were significantly superior to those of open operation. Similar results were observed when analysis was adjusted based on propensity score. Multivariate analyses demonstrated that only age at operation was a poor prognostic factor. CONCLUSION: Laparoscopic Kasai portoenterostomy was associated with several favorable perioperative outcomes compared with open Kasai portoenterostomy. The difference of surgical approach was not a significant independent predictor.