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Laparoscopic vs. open portoenterostomy for biliary atresia: a meta-analysis of pediatric surgical outcomes
1Department of General Surgery, Children's Hospital of Soochow University, Suzhou, China.
Insights
Laparoscopic portoenterostomy (LPE) reduces blood loss and hospital stay for pediatric biliary atresia compared to open portoenterostomy (OPE). However, LPE involves longer operative times, with similar outcomes for jaundice, cholangitis, and survival.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Biliary atresia requires surgical intervention, with portoenterostomy being a key procedure.
- Open portoenterostomy (OPE) is the traditional approach, but minimally invasive techniques are evolving.
Purpose of the Study:
- To compare the efficacy and safety of laparoscopic portoenterostomy (LPE) versus OPE in pediatric biliary atresia.
- To provide evidence-based guidance for selecting surgical approaches in managing biliary atresia.
Main Methods:
- A systematic review and meta-analysis of published studies up to July 10, 2024.
- Inclusion of 15 studies with 964 pediatric patients diagnosed with biliary atresia.
- Data analysis performed using RevMan 5.4 software.
Main Results:
- LPE demonstrated significantly reduced intraoperative blood loss and shorter hospital stays compared to OPE.
- Operative time was longer for LPE than for OPE.
- No significant differences were observed in postoperative jaundice clearance, cholangitis incidence, liver transplantation rates, or 2-year native liver survival.
Conclusions:
- Laparoscopic portoenterostomy (LPE) presents advantages such as decreased invasiveness and faster recovery.
- LPE is a promising alternative for biliary atresia management, meriting further clinical consideration.
- Continued research is essential to fully establish LPE's long-term benefits.
Background:
The pivotal importance of surgical treatment for pediatric biliary atresia is well-established. This systematic review and meta-analysis was designed to assess the comparative efficacy and safety of open portoenterostomy (OPE) and laparoscopic portoenterostomy (LPE) in managing this condition, providing valuable guidance for clinical decision-making.
Methods:
A comprehensive literature review was conducted by two researchers in databases such as PubMed, up to July 10, 2024, focusing on studies that evaluated the role of LPE vs. OPE. Data analysis was performed utilizing the RevMan 5.4 software suite.
Results:
The meta-analysis incorporated findings from 15 studies involving a total of 964 pediatric patients with biliary atresia. LPE was associated with decreased intraoperative blood loss [Mean Difference (MD) = -10.80, 95% Confidence Interval (CI) (-13.54, -8.05)] and shortened hospital stay [MD = -2.18, 95% CI (-3.69, -0.67)]. Conversely, the operative time for LPE was considerably longer when compared to OPE [MD = 35.45, 95% CI (26.17, 44.72)]. No significant disparities were noted in the postoperative jaundice clearance rate [Odds Ratio (OR) = 0.98, 95% CI (0.71, 1.35)], incidence of postoperative cholangitis [OR = 0.96, 95% CI (0.66, 1.39)], the rate of liver transplantation between the two surgical approaches [OR = 0.69, 95% CI (0.32, 1.48)], or 2-year survival of the native liver [OR = 1.10, 95% CI (0.67, 1.80)].
Conclusion:
LPE offers more advantages over OPE, including diminished invasiveness and expedited recovery. These benefits suggest that LPE is an emerging and viable alternative in the clinical management of biliary atresia, warranting further investigation and consideration in surgical practice.
