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Comparison of laparoscopic portoenterostomy and open portoenterostomy for the treatment of biliary atresia

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Abstract

Background

Although open portoenterostomy (OPE) is considered the standard treatment for biliary atresia (BA), laparoscopic portoenterostomy (LPE) is conducted and reported by many investigators. Data on the safety and efficacy of LPE remain controversial. The aim of this meta-analysis is to compare the safety and efficacy of LPE and OPE for the treatment of BA.

Methods

Three electronic databases were searched: PubMed, Embase, and the Cochrane Library. The eligible studies were limited to those published in English. The following keywords were used: “biliary atresia,” “laparoscopic portoenterostomy,” “Kasai portoenterostomy,” “open portoenterostomy,” “surgery,” and “treatment.”

Results

Nine studies, including 434 patients, were analyzed. The operative time of LPE was significantly longer than that of OPE (MD = 40.55 min, 95% CI 4.83–76.27 min, P = 0.03). There was no significant difference between the two groups in terms of the time of hospital stay, the volume of intraoperative blood loss, or the rates of cholangitis, early clearance of jaundice or two-year survival with the native liver. The subgroup analyses revealed that the rate of early clearance of jaundice in the LPE group was significantly higher than that in the OPE group in studies published after 2016 (95% CI 1.04–1.75; P = 0.02).

Conclusions

The present meta-analysis provides evidence that LPE is a feasible option for patients with BA. LPE should be revaluated by further studies and longer follow-up.

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Funding

This project was supported by grants from the National Natural Science Foundation of China (Grants 81401606 and 81400862), the Key Project in the Science & Technology Program of Sichuan Province (Grant 19ZDYF1454), and the Science Foundation for The Excellent Youth Scholars of Sichuan University (Grant 2015SU04A15).

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Authors and Affiliations

  1. Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, #37 Guo-Xue-Xiang, Chengdu, 610041, China

    Yanan Li, Chuan Wang, Zhicheng Xu, Yiyang Zhao & Yi Ji

  2. Department of Operations Management, West China Hospital of Sichuan University, Chengdu, 610041, China

    Jinran Gan

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  1. Yanan Li
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  2. Jinran Gan
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  3. Chuan Wang
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Correspondence to Yi Ji.

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Yanan Li, Chuan Wang, Jinran Gan, Zhicheng Xu, Yiyang Zhao, and Yi Ji have no conflicts of interest or financial ties to disclose.

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Li, Y., Gan, J., Wang, C. et al. Comparison of laparoscopic portoenterostomy and open portoenterostomy for the treatment of biliary atresia. Surg Endosc 33, 3143–3152 (2019). https://doi.org/10.1007/s00464-019-06905-9

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  • DOI: https://doi.org/10.1007/s00464-019-06905-9

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