Evaluation of surgical correction of biliary atresia in infants depending on the method
DOI:
https://doi.org/10.15574/PP.2025.3(103).137143Keywords:
infants, biliary atresia, chronic cholestasis, Kasai operation, laparoscopy, laparotomyAbstract
Aim - comparison of the results of Kasai operation (KO), performed laparoscopically and laparotomically, according to the main clinical and laboratory indicators 6 months after the intervention. To justify the rational choice of priority access as the standard of surgical treatment of biliary atresia (BA), taking into account technical, anatomical and prognostic aspects, based on the study of clinical and laboratory features of the course of BA in infants.
Materials and methods. A retrospective analysis of 64 cases of BA in children under 6 months of age is presented. The main method of primary treatment in all patients was KO. This allowed to partially or completely restore bile outflow and stabilize the patient's condition before liver transplantation (LT) in 43 patients. The remaining 21 patients have a satisfactory state of bile outflow after undergoing KO and have not had indications for LT to date. All patients underwent comprehensive diagnostics, including clinical and biochemical studies, ultrasound diagnostics, endoscopy, liver biopsy and genetic studies. Laparoscopic KO was performed only in 4 children (type 1 BA), while laparotomic OC was performed in 60 patients (types 2a and 3).
The results of surgical interventions were evaluated in the early postoperative period and 6 months after surgery according to clinical (assessment of physical and neuropsychiatric development, stool color, restoration of skin and mucous membrane color), biochemical parameters (levels of direct bilirubin, alanineaminotransferase, aspartateaminotransferase, fibrinogen, platelets, body mass index). Re-evaluation of these parameters was carried out after 6 months.
Conclusions. Laparotomic approach to KO is considered the optimal method of intervention due to the anatomical conditions of the intervention area, technical features of the technique and its precision, tightness of the anastomosis formation, and duration of the operation. Laparoscopic KO did not show significant advantages in the short-term prognosis in the effectiveness of normalization of clinical and laboratory indicators. The importance of early diagnosis, multidisciplinary approach, and timely surgical intervention as key factors in the successful treatment of BA is emphasized.
The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child and child's parents was obtained for the research.
The author declares no conflict of interest.
References
Antala S, Taylor SA. (2022, Aug). Biliary Atresia in Children: Update on Disease Mechanism, Therapies, and Patient Outcomes. Clin Liver Dis. 26(3): 341-354. Epub 2022 Jun 25. https://doi.org/10.1016/j.cld.2022.03.001; PMid:35868678 PMCid:PMC9309872
Brahee DD, Lampl BS. (2022, Apr). Neonatal diagnosis of biliary atresia: a practical review and update. Pediatr Radiol. 52(4): 685-692. Epub 2021 Jul 31. https://doi.org/10.1007/s00247-021-05148-y; PMid:34331566
Cazares J, Koga H, Yamataka A. (2024, Dec). Advances in the surgical technique of Kasai portoenterostomy. Semin Pediatr Surg. 33(6): 151481. Epub 2025 Feb 28. https://doi.org/10.1016/j.sempedsurg.2025.151481; PMid:40054302
De Onis M. (2015). 4.1 The WHO Child Growth Standards. World Rev Nutr Diet. 113: 278-294. https://doi.org/10.1159/000360352; PMid:25906897
Glantz SA. (2012). Primer of Biostatistics. Seventh Edition. Stanton A. Glantz. McGraw-Hill Professional: 320.
Gorbatyuk OM, Makedonsky IA, Kurilo HV. (2019). Modern strategies of the diagnostics, surgical correction and prevention of congenital anomalies in newborns. Neonatology, Surgery and Perinatal Medicine. 4(34): 88-97. https://doi.org/10.24061/2413-4260.IX.4.34.2019.7
Grisotti G, Cowles RA. (2016, Dec). Complications in pediatric hepatobiliary surgery. Semin Pediatr Surg. 25(6): 388-394. Epub 2016 Oct 29. https://doi.org/10.1053/j.sempedsurg.2016.10.004; PMid:27989363
Hackl C, Schmidt KM, Süsal C, Döhler B, Zidek M, Schlitt HJ. (2018, Dec 21). Split liver transplantation: Current developments. World J Gastroenterol. 24(47): 5312-5321. https://doi.org/10.3748/wjg.v24.i47.5312; PMid:30598576 PMCid:PMC6305537
Harada A, Kurobe M. (2022, Jan). Neonatal portal thrombosis in biliary atresia after Kasai procedure. Pediatr Int. 64(1): e15262. https://doi.org/10.1111/ped.15262; PMid:35938607
Hussain MH, Alizai N, Patel B. (2017, Feb). Outcomes of laparoscopic Kasai portoenterostomy for biliary atresia: A systematic review. J Pediatr Surg. 52(2): 264-267. Epub 2016 Nov 14. https://doi.org/10.1016/j.jpedsurg.2016.11.022; PMid:28007417
Kasai M, Cipriani F, Gayet B, Aldrighetti L, Ratti F, Sarmiento JM et al. (2018, May). Laparoscopic versus open major hepatectomy: a systematic review and meta-analysis of individual patient data. Surgery. 163(5): 985-995. Epub 2018 Mar 16. https://doi.org/10.1016/j.surg.2018.01.020; PMid:29555197
Kelley-Quon LI, Shue E, Burke RV, Smith C, Kling K, Mahdi E et al. (2022, Feb). The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study. Pediatr Surg Int. 38(2): 193-199. Epub 2021 Dec 2. https://doi.org/10.1007/s00383-021-05047-1; PMid:34854975 PMCid:PMC8742784
Kiblawi R, Zoeller C, Zanini A, Kuebler JF, Dingemann C et al. (2022, Feb). Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies. Eur J Pediatr Surg. 32(1): 9-25. Epub 2021 Dec 21. https://doi.org/10.1055/s-0041-1739418; PMid:34933374
Kurylo HV. (2024). Alagille syndrome in the clinical practice of a paediatric surgeon. Paediatric Surgery (Ukraine). 2(83): 49-56. https://doi.org/10.15574/PS.2024.83.49
Kurylo HV. (2024). Byler's disease: conservative and surgical treatment strategies. Paediatric Surgery (Ukraine). 3(84): 117-123. https://doi.org/10.15574/PS.2024.3(84).117123
Kurylo HV. (2025). Liver transplantation in children: pre-transplantation preparation tactics. Paediatric Surgery (Ukraine). 1(86): 40-44. [Курило ГВ. (2025). Трансплантація печінки в дітей: тактика дотрансплантаційної підготовки. Хірургія дитячого віку (Україна). 1(86): 40-44. https://doi.org/10.15574/PS.2025.1(86).4044
Kurylo HV. (2025). Transplant surgeon's strategies in cases of cholestatic jaundice in children of the first months of life. Modern Pediatrics. Ukraine. 3(147): 60-66. https://doi.org/10.15574/SP.2025.3(147).6066
Lau NS, Jacques A, McCaughan G, Crawford M, Liu K, Pulitano C. (2021, Jul). Addressing the challenges of split liver transplantation through technical advances. A systematic review. Transplant Rev (Orlando). 35(3): 100627. Epub 2021 May 19. https://doi.org/10.1016/j.trre.2021.100627; PMid:34052472
Lendahl U, Lui VCH, Chung PHY, Tam PKH. (2021, Dec). Biliary Atresia - emerging diagnostic and therapy opportunities. EBioMedicine. 74: 103689. Epub 2021 Nov 12. https://doi.org/10.1016/j.ebiom.2021.103689; PMid:34781099 PMCid:PMC8604670
Madadi-Sanjani O, Petersen C, Ure B. (2017, Dec). Minimally Invasive Hepatobiliary Surgery. Clin Perinatol. 44(4): 805-818. Epub 2017 Sep 14. https://doi.org/10.1016/j.clp.2017.08.004; PMid:29127962
Maydannyk VH, Burlay VH, Hnateyko OZ, Duka KD, Nechytaylo YuM. (2018). Propedevtychna pediatriya. Pidruch. dlya stud. vyshch. med. navch. zakl. IV rivnya akredytatsiyi. Za red. Maydannyk Vitaliy Hryhorovych. Vyd. 2-he, vypr. ta dopov. Vinnytsya: Nova knyha: 163.
Nguyen AP, Pham YHT, Vu GH, Nguyen MH, Hoang TN, Holterman A. (2021, Jul). Biliary atresia liver histopathological determinants of early post-Kasai outcome. J Pediatr Surg. 56(7): 1169-1173. Epub 2021 Mar 26. https://doi.org/10.1016/j.jpedsurg.2021.03.039; PMid:33838902
NSZU. (2024). Likuvannya doroslykh ta ditey metodom transplantatsiyi orhaniv. Vymohy do paketu na sayti NSZU, punkt 42. URL: https://contracting.nszu.gov.ua/kontraktuvannya/kontraktuvannya-2024-1699952970/vimogi-pmg-2024.
Stetson A, Bondoc A, Tiao G. (2024, Dec). Revision Kasai portoenterostomy: A review of indications and outcomes. Semin Pediatr Surg. 33(6): 151476. Epub 2025 Jan 16. https://doi.org/10.1016/j.sempedsurg.2025.151476; PMid:39881457
Tam PKH, Wells RG, Tang CSM, Lui VCH, Hukkinen M, Luque CD et al. (2024, Jul 11). Biliary atresia. Nat Rev Dis Primers. 10(1): 47. https://doi.org/10.1038/s41572-024-00533-x; PMid:38992031 PMCid:PMC11956545
Weir CB, Jan A. (2023, Jun 26). BMI Classification Percentile And Cut Off Points. In: StatPearls.
Zhang Y, Liu S, Yang Q, Sun R, Liu J, Meng Y, Zhan J. (2024, Nov 27). Comparison of different Kasai portoenterostomy techniques in the outcomes of biliary atresia: a systematic review and network meta-analysis. Pediatr Surg Int. 41(1): 6. https://doi.org/10.1007/s00383-024-05920-9; PMid:39592482
Zhan J, Liu S, Li T, Li X. (2024, Dec 1). Kasai procedure or liver transplantation: how should we choose in biliary atresia? Hepatobiliary Surg Nutr. 13(6): 1019-1021. Epub 2024 Nov 19. https://doi.org/10.21037/hbsn-24-509; PMid:39669068 PMCid:PMC11634429
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