Laparoscopic Kasai Portoenterostomy - Technical Challenges, Modifications, and Outcomes
Kirtikumar J Rathod1, Ayushi Vig2, Darshana Rathod3
1Department of Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Introduction:
Laparoscopic Kasai operation stands as one of the most intricate laparoscopic procedures and its efficacy in treating biliary atresia remains a subject of controversy till date. We have performed five laparoscopic Kasai procedures and here we describe the technical modifications and our initial results.
Materials And Methods:
We performed a retrospective analysis of a total of five cases of biliary atresia performed laparoscopically over the last 5 years at our institution. We have used three ports and indocyanine green guidance for determining the accurate extent and depth of dissection of the fibrous portal plate.
Results:
All patients undergoing laparoscopic Kasai Portoenterostomy had a smooth postoperative transit. The mean total bilirubin at 6 months' follow-up was 2.33 mg/dl (0.5-4.5 mg/dl). Two patients were anicteric on the most recent postoperative visit. Laparoscopic Kasai porto-enterostomy is recognized for minimizing blood loss, reducing the need for opioids and for causing lesser adhesions at the porta thereby making future liver transplantation comparatively easy.
Conclusion:
We conclude that although laparoscopic Kasai porto-enterostomy is a technically challenging procedure, however, it can safely be performed by experienced laparoscopic pediatric surgeons.
