Comparison of different Kasai portoenterostomy techniques in the outcomes of biliary atresia: a systematic review and network meta-analysis
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In brief
In brief
This systematic review compares three Kasai portoenterostomy techniques for biliary atresia: open, laparoscopic, and robot-assisted approaches. While robotic surgery showed trends toward better jaundice clearance, no statistically significant differences emerged in success rates or long-term liver survival across techniques, suggesting surgical choice should be individualized based on patient factors and resource availability.
- Robot-assisted KPE shows trend toward better jaundice clearance vs open/laparoscopic approaches, but differences are not statistically significant.
- Laparoscopic KPE has longer operative time but less intraoperative bleeding compared to open technique; hospital stay and complication rates similar.
- No significant differences in cholangitis incidence or liver survival rates at 6 months to 5 years across all three KPE techniques.
- Surgical technique selection should be individualized based on patient factors and cost, as success rates are comparable across approaches.
- Effective postoperative management is critical for preventing complications and slowing liver fibrosis; timely liver transplant needed when KPE fails.
Written by the GCMD Library team from the article.
Abstract
Background
Biliary atresia (BA) is a progressive disease affecting the bile duct structure and function, leading to poor outcomes without timely surgical intervention. Kasai portoenterostomy (KPE) is a commonly used treatment to restore bile flow. However, the success rate and postoperative outcomes of KPE vary with different surgical techniques, including laparoscopic, robot-assisted, and open approaches.
Methods
Following the PRISMA guidelines, this study systematically searched PubMed, EMBASE, and Cochrane databases for literature on BA surgical techniques of KPE. Studies comparing two or all three techniques—laparoscopic, robot-assisted, and open—in terms of postoperative outcomes of KPE in BA patients were included. Utilizing the "gemtc" package in R version 4.3.3, NMA was conducted to compare postoperative clearance of jaundice (COJ) among different surgical techniques. We also performed traditional paired meta-analysis in which multiple surgical outcomes were compared.
Results
According to the traditional definition of a successful KPE surgery, in terms of successful postoperative COJ, robotic-assisted Kasai portoenterostomy (RAKPE) shows advantage over open Kasai portoenterostomy (OKPE) and laparoscopic Kasai portoenterostomy (LKPE), while the outcomes between OKPE and LKPE are equivalent. However, statistically speaking, there is no significant difference among the three techniques. LKPE has a longer operation time and less intraoperative bleeding compared to OKPE. There are no statistically significant differences in hospital stay, cholangitis incidence, or liver survival rates at 6 months, 1 year, 2 years, or 5 years.
Conclusion
The surgical success rates of KPE with various technical aids are similar, highlighting the need to consider individual patient conditions and cost when choosing a surgical technique. Effective postoperative management is vital for preventing complications and slowing liver fibrosis. Future research should focus on improving surgical techniques and postoperative care to enhance long-term outcomes for BA patients. For those who cannot maintain liver function with KPE, timely LT consideration is crucial.