Liver mobilization during Kasai portoenterostomy: retrospective multicentre analysis
Marie Uecker1,2, Maximilian Holweg3, Maria Hukkinen4
1Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
Background:
Liver mobilization (LM) during Kasai portoenterostomy (KPE) is used by some surgeons to improve exposure but remains controversial due to anaesthetic challenges and concerns about increased adhesions complicating liver transplantation (LT). This study evaluated the impact of LM on intraoperative, postoperative, and long-term outcomes in biliary atresia.
Methods:
A multicentre case-control study involving high-volume biliary atresia centres in Europe and North America was conducted. Preoperative, intraoperative, and postoperative clinical and laboratory data were retrospectively collected and comparisons were made between groups with and without LM. Long-term native liver survival was assessed by Kaplan-Meier analysis with log-rank testing.
Results:
In all, 204 patients were included in the study: 142 in the LM group and 62 in the No LM group. During KPE, the LM group received catecholamines more frequently (100 (100%) versus 13 (46%) patients; P < 0.001), required more intravenous fluids (116.2 versus 79.15 ml/kg; P < 0.014), and had higher transfusion rates (18.91 versus 7.59 ml/kg; P < 0.001) than the No LM group. After KPE, transaminases were elevated in both groups, but significantly higher in the LM group (aspartate aminotransferase, 1166 versus 374.6 U/l; P < 0.001; alanine aminotransferase 456.8 versus 206.7 U/l; P < 0.001). These values normalized within 7 days after KPE. During subsequent LT, patients who had undergone LM experienced significantly shorter operative times (295.3 versus 509.8 minutes; P < 0.001) and required lower blood transfusion volumes (55.26 versus 95.81 ml/kg; P < 0.001). Of note, patients who underwent LM showed significantly prolonged native liver survival (P < 0.024).
Conclusions:
LM during KPE leads to increased intraoperative haemodynamic compromise requiring more intensive anaesthetic management and causes transient postoperative hepatic stress. LM does not appear to negatively affect LT and is associated with improved long-term native liver survival. These findings suggest potential benefits of LM during KPE, warranting further investigation in prospective studies.
