[Video-assisted treatment for biliary atresia].

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Hepatobiliary Surgery

Background:

• Biliary atresia treatment remains challenging, with traditional Kasai's operation often causing significant post-operative pain and adhesions via laparotomy.
• Minimally invasive surgical advancements offer potential solutions to mitigate these complications and improve patient recovery.

Observation:

• A successful Roux-en-Y laparoscopic portoenterostomy was performed on a 3-month-old infant weighing 5.3 kg for biliary atresia.
• The procedure utilized four 3 mm trocars and one 10 mm trocar, with CO2 insufflation at 8 mmHg.
• Extracorporeal Roux-en-Y enteroenterostomy was performed via the umbilical site, with a drain placed near the anastomosis.

Findings:

• The laparoscopic Kasai portoenterostomy was completed without intraoperative or post-operative complications.
• Nasogastric tube feeding commenced on postoperative day 2, with full oral feeding achieved by day 8.

Implications:

• Laparoscopic Kasai portoenterostomy provides excellent visualization of portal structures and adequate liver retraction, potentially reducing post-operative pain, adhesions, and scarring.
• This minimally invasive approach is technically feasible for experienced surgeons and may improve outcomes and facilitate subsequent liver transplantation.