A prospective study comparing laparoscopic and conventional Kasai portoenterostomy in children with biliary atresia

Objective The objective of the study is to evaluate the outcome of laparoscopic Kasai portoenterostomy for type III biliary atresia in children. Methods A total of 95 type III biliary atresia patients were treated at the Capital Institute of Pediatrics between September 2009 and August 2011. The patients were randomized into 2 groups preoperatively: the laparoscopic group (LP group, n = 48) and the open group (OP group, n = 47). In the LP group, 4 patients were converted to open operations, whereas the remaining 44 patients in the LP group and 47 patients in the OP group were included in the study. Results The gender distribution and age of the LP group did not differ from those of the OP group (LP group F/M 21/23, median age 61.5 days, OP group F/M 24/23, median age 67 days, P = 0.75 and 0.11). The operation time in the LP group was significantly longer than that in the OP group (median 169.5 min vs 146 min, P < 0.01). Intraoperative blood loss in the LP group was significantly lower than in the OP group (median 10 ml vs 15 ml, P < 0.01). The resumption oral intake was significantly faster in the LP group than in the OP group (median 3 days vs 3 days, P < 0.01). There were no significant differences between the postoperative hospital stay in the two groups (median 12.5 days vs 13 days, P = 0.21). The median follow-up period was 16 months in the LP group and 17 months in the OP group. There was no statistically significant difference in the jaundice clearance rate at the end of the third postoperative month or in the incidence of cholangitis, native liver survival rate, and liver function recovery between the 2 groups. Conclusions The short-term and mid-term results are comparable between the laparoscopic and open Kasai portoenterostomy groups. The laparoscopic Kasai procedure does not improve the prognosis of biliary atresia.