A comparison study of laparoscopic versus open portoenterostomy for pediatric biliary atresia / 中国微创外科杂志

ABSTRACT

Objective To investigate whether the laparoscopic portoenterostomy is superior to open surgery in the treatment of biliary atresia.Methods A total of 26 children with type Ⅲ biliary atresia underwent laparoscopic portoenterostomy from August 2003 to September 2005(Laparoscopic Group).The operation was performed under 4-port laparoscopy.The hepatic portal was fully exposed and mobilized and the gallbladder was removed.The cut end of the duct was widened by incising along the anterior wall of the hepatic duct following the excision of the narrow segment.By using intraoperative bile duct endoscopy,the optimal level of resection of the common hepatic duct was determined without endangering the orifices of the hepatic ducts or leaving any redundant duct.The Roux-en-Y jejunal loop was fashioned extracorporeally by exteriorizing the jejunum for 40 cm in length distally through the umbilical incision and passed up retrocolically followed by an end-to-side hepaticojejunostomy.They were compared with other group of 34 children,with the same age range and diagnosis,who underwent open portoenterostomy(Open Group) in the same period,in respect of the operative time,the blood loss,the liver functions,complications,the length of hospital stay,the hospitalization expenditure,and the short-term outcomes. Results As compared with the Open Group,the Laparoscopic Group presented a less blood loss(15.4?5.0 ml vs 33.8?19.4 ml;t=-4.709,P=0.000) and a higher hospitalization expenditure(19 153.9?619.5 yuan vs 15 116.7?898.4 yuan;(t=19.607),P=0.000).There were no significant differences between the two groups in the operative time and the length of hospital stay.The serum levels of total bilirubin,direct bilirubin,ALT,and AST were deceased more significantly in the Laparoscopic Group than in the Open Group.Complications happened in 1 case in the Laparoscopic Group(incisional hernia) and in 4 cases in the Open Group(1 case of acute hepatic failure,1 case of incision rupture,and 2 cases of wound infection),the incidence of complications being not significant(?~2=0.395,P=0.530).Follow-up observations at 4 postoperative month found the jaundice had subsided in 13 cases in the Laparoscopic Group(50%) and in 18 cases in the Open Group(53%). Conclusions Laparoscopic portoenterostomy is a minimally invasive,safe,and effective procedure for the treatment of pediatric biliary atresia.