Clinical School of Paediatrics, Tianjin Medical University, Tianjin, 300400, China.
Department of General Surgery, Tianjin Children's Hospital, Tianjin, 300134, China.
Pediatr Surg Int. 2024 Nov 27;41(1):6. doi: 10.1007/s00383-024-05920-9.
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.
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.
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.
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.
胆道闭锁（BA）是一种影响胆管结构和功能的进行性疾病，如果不及时进行手术干预，预后较差。Kasai 胆管空肠吻合术（KPE）是一种常用的治疗方法，可恢复胆汁流动。然而，KPE 的成功率和术后结果因不同的手术技术而有所不同，包括腹腔镜、机器人辅助和开放方法。
根据 PRISMA 指南，本研究系统地检索了 PubMed、EMBASE 和 Cochrane 数据库中关于 BA 手术技术 KPE 的文献。纳入了比较腹腔镜、机器人辅助和开放三种技术在 BA 患者 KPE 术后结果的研究。利用 R 版本 4.3.3 中的“gemtc”包，进行 NMA 比较不同手术技术术后黄疸消退（COJ）情况。我们还进行了传统的配对荟萃分析，比较了多种手术结果。
根据 KPE 手术成功的传统定义，在成功的术后 COJ 方面，机器人辅助 Kasai 胆管空肠吻合术（RAKPE）优于开放 Kasai 胆管空肠吻合术（OKPE）和腹腔镜 Kasai 胆管空肠吻合术（LKPE），而 OKPE 和 LKPE 之间的结果相当。然而，从统计学上讲，这三种技术之间没有显著差异。与 OKPE 相比，LKPE 的手术时间更长，术中出血量更少。在住院时间、胆管炎发生率或 6 个月、1 年、2 年或 5 年的肝存活率方面，无统计学差异。
各种技术辅助下的 KPE 手术成功率相似，这表明在选择手术技术时需要考虑患者个体情况和成本。有效的术后管理对于预防并发症和减缓肝纤维化至关重要。未来的研究应侧重于改善手术技术和术后护理，以提高 BA 患者的长期结果。对于那些无法通过 KPE 维持肝功能的患者，及时考虑 LT 至关重要。
