From laparoscopic to open Kasai portoenterostomy: the outcome after reintroduction of open Kasai portoenterostomy in infant with biliary atresia.

PURPOSE: Apparently superior result was observed after open Kasai portoenterostomy in infant with biliary atresia. Our institute stopped performing laparoscopic portoenterostomy since 2007. We aimed to investigate the outcome after reintroduction of open portoenterostomy. METHODS: 27 non-syndromic infants underwent open Kasai portoenterostomy from 2007 to 2012. The age and the sex of the patient, the bilirubin level before the operation, the early clearance of jaundice (total bilirubin <20 µmol/L within 6 month of portoenterostomy), the native liver survival at 2 years after the operation were reviewed. The results were retrospectively compared with all 16 infants who underwent laparoscopic Kasai portoenterostomy before 2007. RESULTS: All infants had type III biliary atresia. No statistical difference was observed regarding the age at operation and the pre-operative bilirubin level. The early clearance of jaundice rate was 81% (22/27) after open operation and was 50% (8/16) after laparoscopic operation (p = 0.03). At 2 years after the operation, the native liver survival was 81% (22/27) after open operation and was 50% (8/16) after laparoscopic operation (p = 0.03). CONCLUSION: Reintroduction of open Kasai portoenterostomy was associated with superior early clearance of jaundice rate and 2-year native liver survival rate.

Laparoscopic versus open Kasai portoenterostomy in infant with biliary atresia: a retrospective review on the 5-year native liver survival.

PURPOSE: Laparoscopic Kasai portoenterostomy was reported to be a safe and feasible procedure in infant with biliary atresia. We aimed to investigate the long-term results after laparoscopic portoenterostomy as such data in the literature are lacking. METHODS: Sixteen infants underwent laparoscopic Kasai portoenterostomy from 2002 to 2006. The age and the sex of the patient, the bilirubin level before the operation, the early clearance of jaundice (total bilirubin <20 µmol/L within 6 months of portoenterostomy), the native liver survival at 2 and 5 years after the operation were reviewed. The results were retrospectively compared with 16 consecutive infants who underwent open Kasai portoenterostomy before 2002. RESULTS: All infants had type III biliary atresia. The early clearance of jaundice rate at 6 months was 50 % (8/16) after laparoscopic operation and was 75 % (12/16) after open operation (p = 0.144). Two years after the operation, the native liver survival was 50 % (8/16) in the laparoscopic group and was 81 % (13/16) in the open group (p = 0.076). Five years after the operation, the native liver survival rate was 50 % (8/16) in the laparoscopic group and was 81 % (13/16) in the open group (p = 0.076). The jaundice-free native liver survival rate at 5 years was 50 % (8/16) in laparoscopic group and was 75 % (12/16) in the open group. In the laparoscopic group, all patients with early clearance of jaundice survived and remained jaundice freed 5 years after the operation. CONCLUSION: The 5-year native liver survival rate after laparoscopic portoenterostomy was 50 %. Apparently superior result was observed in the open group (81 %) although the figures did not reach statistical difference because of the small sample size. A larger scale study is required to draw a more meaningful conclusion.

Early experience of robotic-assisted reconstructive operations in pediatric urology.

OBJECTIVES: Laparoscopic pyeloplasty and ureteric reimplantation are complex urologic operations requiring delicate surgical skill. The use of a robot may provide benefits in performing these reconstructive operations. In this article, we report our early experience in the use of the robot in pediatric urologic operations. METHODS: Children who underwent robotic-assisted reconstructive urologic operations were reviewed and analyzed. RESULTS: From November 2005 to April 2008, 8 children underwent robotic-assisted reconstructive urologic operations. Three children had extravesical ureteral reimplantation performed for vesicoureteric reflux (VUR), and 5 children had pyeloplasty performed for pelvic-ureteric junction obstruction. There was no conversion to open procedure and no intraoperative complication. The operative time ranged from 105 to 420 minutes (mean, 219). Postoperatively, 1 patient had urinary retention and 1 patient had postoperative fever. Hospital stay ranged from 3 to 10 days (mean, 4.8). Mean follow-up time was 38 months (range, 17-46). VURs were resolved for the 2 children with simple VUR and was downgraded for the child with duplex kidney. All patients who underwent pyeloplasty showed satisfactory urinary drainage after the operation. CONCLUSIONS: From this early experience, robotic-assisted urologic operations in children were safe and feasible. It was particularly useful in reconstructive operations that required precise suturing, such as ureteric reimplantation and pyeloplasty.