K. Yano1, K. Sugita1, Y. Gohda2, W. Sumida2, T. Harumatsu1, S. Onishi1, T. Kawano1, S. Makita2, T. Tainaka2, C. Shirota2, A. Hinoki2, H. Uchida2, S. Ieiri1 1Kagoshima University, Pediatric Surgery, Kagoshima, KAGOSHIMA, Japan 2Nagoya University, Pediatric Surgery, Nagoya, NAGOYA, Japan
Introduction: The comparison of operative outcomes between laparoscopic Kasai procedure (LKP) and open Kasai procedure (OKP) for biliary atresia (BA) is controversial. We aimed to clarify the postoperative clinical course and operative results of LKP and OKP for BA in 2 institutions.
Methods: Patients with BA who underwent the Kasai procedure between 2003 and 2023 were recruited from two institutions. Patient background characteristics, postoperative clinical course, and operative outcomes were compared.
Results: This study included 182 patients from 2 institutions. The OKP and LKP groups included 106 (58.2%) and 76 (41.8%) patients, respectively. The median age at the Kasai procedure was significantly different (OKP group vs. LKP group: 65.0 [56–77.75] days vs. 54.5 [38.25–70.50] days, p=0.000106). The rate of native liver survival (NLS) was significantly higher in the LKP group (OKP group vs. LKP group: 66.0% vs. 83.6%, p=0.0102).
Age was determined as a confounding factor and propensity score matching (PSM) was performed. Regarding the analysis by PSM, the comparison of the OKP and LKP group revealed the following results (all OKP vs. LKP): age at Kasai procedure, 58.0 days vs. 58.0 days (p=0.972); sex (male: female), 19:40 vs. 20:39 (p=1.00); rate of NLS (n, %), 40 (67.8%) vs. 48 (84.2%) (p=0.051).
In each group, the CRP levels at different postoperative time points in patients with NLS and those who received liver transplantation (LT) were as follows (all NLS vs. LT):
OKP group: postoperative week (POW) 1, 0.99 mg/dl vs. 0.86 mg/dl (p=0.772); POW 2, 0.37 mg/dl vs. 0.37 mg/dl (p=0.873); POW 3, 0.19 mg/dl vs. 0.23 mg/dl (p=0.553); POW 6, 0.47 mg/dl vs. 0.42 mg/dl (p=0.817); POW 12, 0.69 mg/dl vs. 0.50 mg/dl (p=0.664); POW 24, 0.34 mg/dl vs. 0.92 mg/dl (p=0.123) (Figure 1a).
LKP group: POW 1, 0.79 mg/dl vs. 0.63 mg/dl (p=0.606); POW 2, 0.73 mg/dl vs. 0.91 mg/dl (p=0.708); POW 3, 0.51 mg/dl vs. 0.29 mg/dl (p=0.24); POW 6, 0.79 mg/dl vs. 0.77 mg/dl (p=0.984); POW 12, 1.35 mg/dl vs. LT 1.15 mg/dl (p=0.805) (Figure 1b).
Conclusion: Based on the PSM study, patients with BA who underwent LKP had better operative outcomes. Postoperative CRP levels were not correlated with the postoperative course.