Comprehensive assessment of prognosis after laparoscopic portoenterostomy for biliary atresia
Hiroki Nakamura1, Hiroyuki Koga1, Joel Cazares2
1Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Insights
Laparoscopic portoenterostomy (LPE) showed better jaundice clearance than open portoenterostomy (OPE) in biliary atresia patients. However, open procedures resulted in better biochemical markers, indicating potential long-term benefits.
Area of Science:
- Pediatric surgery
- Hepatology
- Gastroenterology
Background:
- Biliary atresia (BA) is a neonatal liver disease requiring portoenterostomy (PE).
- Total bilirubin (T-bil) is a standard marker for monitoring PE success.
- AST/ALT and platelet count (PC) also offer prognostic information.
Purpose of the Study:
- To compare open PE (OPE) and laparoscopic PE (LPE) in biliary atresia patients.
- To evaluate T-bil, AST/ALT, and PC (3BM) as comprehensive indicators of postoperative outcomes.
Main Methods:
- A cohort of 31 PE cases (17 LPE, 14 OPE) was analyzed.
- Patients were classified by BA type (III, I, II).
- Outcomes were assessed based on jaundice clearance and 3BM levels.
Main Results:
- Jaundice clearance was higher after LPE (94.1%) compared to OPE (71.4%).
- Biochemical markers (3BM) were closer to normal after OPE.
- Native liver survival rates were similar: 76.5% for LPE and 71.4% for OPE.
Conclusions:
- LPE demonstrated superior jaundice clearance post-portoenterostomy.
- OPE showed better biochemical marker normalization, suggesting prognostic value.
- Further follow-up is needed to fully assess the long-term prognostic significance of 3BM.
Purpose:
Total bilirubin (T-bil) is used universally for monitoring post-portoenterostomy (PE) biliary atresia (BA) patients although other biochemical markers [BM; AST/ALT and platelet count (PC)] are also prognostic. We compared open PE (OPE) with laparoscopic PE (LPE) using T-bil, AST/ALT, and PC (3BM) as more comprehensive indicators of postoperative clinical status.
Methods:
Subjects were 31 PE cases (LPE: n = 17; OPE: n = 14). BA classification was type III (n = 16), type II (n = 1) in LPE and type III (n = 12), type I (n = 1), type II (n = 1) in OPE.
Results:
Mean ages and weights at PE were similar: 65.5 days, 4.4 kg (LPE) versus 69.3 days, 4.1 kg (OPE); and mean follow-up was 2.5 years for both LPE and OPE. Jaundice clearance (T-bil ≤1.2 mg/dL) was achieved in 16/17 (94.1 %) after LPE versus 10/14 (71.4 %) after OPE (p = NS), but 3BM were closer to normal after OPE. At the time of review, 13/17 LPE cases (76.5 %) were alive with native livers and 4/17 had received LTx (23.5 %) and 10/14 OPE cases (71.4 %) were alive with native livers and 4/14 had received LTx (28.6 %).
Conclusions:
Although JC was better after LPE, 3BM were better after OPE. Further follow-up will prove the comprehensive prognostic value of 3BM.
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