Evaluation Of The Curative Efficacy Of Laparoscopic And Open Kasai Portoenterostomy In The Treatment Of Biliary Atresia

Objective: To evaluate the efficacy of laparoscopic and open Kasai portoenterostomy in the treatment of type III biliary atresia and its effect on liver transplantation.Methods: The clinical data of type III biliary atresia patients underwent Kasai surgery in our center from January 2014 to January 2018 were retrospectively analyzed.They were divided into laparoscopic portoenterostomy group(LPE)and open portoenterostomy group(OPE).Patients underwent liver transplantation were divided into two subgroups: liver transplantation after laparoscopic portoenterostomy subgroup(LTLPE)and liver transplantation after open portoenterostomy subgroup(LTOPE).Compared and analyzed the clinical data of preoperation,intraoperation,postoperation.The following-up time cut off January 1,2020.Results: 115 cases were entered this study,among them,54 cases were into LPE group and 61 cases were into OPE group.There were no significant differences between LPE and OPE in operation age,weight,there was comparability between the two groups.There were no significant differences between LPE and OPE in intraoperative blood loss,episodes of cholangitis and jaundice clearance rate(P>0.05).TBIL,ALT of pre-operation and 1 month,3months,6 months after surgery had no statistical difference(P>0.05).The operative time of LPE was longer than that of OPE(229 vs.126 min,P<0.01),the first feeding time of LPE was shorter than that of OPE(2 vs.3d,P<0.01),the hospitalization days of LPE were shorter than that of OPE(19 vs.21 d,P<0.01).The early postoperative fever rate in the LPE group was lower than that in the OPE group(37.0% vs.80.3%,P<0.01),and the incision length in the LPE group was shorter than that in the OPE group(1.8 vs.11 cm,P<0.01).WBC,NEU%of pre-operation and 1 day after surgery had no statistical difference(P>0.05).There were no significant differences in preoperative and postoperative WBC in two groups(P>0.05),the postoperative NEU% was larger than preoperative NEU% in two groups(P<0.05).The 1-year survival rate of native liver of LPE and OPE were 79.6% and 72.1%(P=0.35),the 2-year survival rate of native liver of the groups were 70.4% and 57.4%(P=0.149),the 4-year survival rate of native liver of the groups were 63.0% and 55.7%(P=0.432),respectively.And the 1-year survival rate of the groups were 83.3% and 75.4%(P=0.297),the2-year survival rate of the groups were 74.1% and 62.3%(P=0.177),the 4-year survival rate of the groups were 72.2% and 60.7%(P=0.191),respectively.The clinical data of 9 patients underwent Kasai postoperative liver transplantation were retrospectively analyzed,5 cases in LTLPE subgroup and 4 cases in LTOPE subgroup.There were no significant differences in age,weight and PELD score(P>0.05),however,LTLPE had lower abdominal cavity adhesion score(3 vs.10,P=0.024),shorter operation time(587 vs.844 min,P=0.027),shorter liver resection time(132 vs.278 min,P=0.037),less bleeding(430 vs.947.5ml,P=0.027).Conclusions: Laparoscopic Kasai portoenterostomy has similar effect to open Kasai portoenterostomy in the surgical treatment of type III biliary atresia,which is conducive to the implementation of liver transplantation.