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A New Era of Laparoscopic Revision of Kasai Portoenterostomy for the Treatment of Biliary Atresia.

Murase N, Uchida H, Ono Y, Tainaka T, Yokota K, Tanano A, Shirota C, Shirotsuki R - Biomed Res Int (2015)

Bottom Line: If Kasai is unsuccessful, there is controversy over whether revision of Kasai restores adequate biliary drainage.The bilirubin level was normalized by Lap-revision in all four patients, and three of them were alive with their native liver.Lap-revision is a feasible and effective method for the treatment of BA and might herald a new era for the treatment of this disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya 466-8550, Japan.

ABSTRACT

Purpose: Kasai portoenterostomy is the standard therapy for biliary atresia (BA). If Kasai is unsuccessful, there is controversy over whether revision of Kasai restores adequate biliary drainage. Although there are several reports of laparoscopic Kasai (Lap-Kasai), none has described laparoscopic revision (Lap-revision). The purposes of this study were to evaluate the feasibility and efficacy of Lap-revision.

Methods: 65 patients underwent open Kasai between November 2001 and November 2013, and 12 patients underwent Lap-Kasai between December 2013 to January 2015. The indications for revision included bile flow cessation and recurrent cholangitis. Clinical data were compared between open and laparoscopic revisions of Kasai.

Results: Open revision of Kasai was performed in 20 patients after open Kasai, and Lap-revision was performed in 4 patients after Lap-Kasai. Lap-revision was completed without conversion or major complication in any patient. The bilirubin level was normalized by Lap-revision in all four patients, and three of them were alive with their native liver. Open and laparoscopic revisions of Kasai were comparable in terms of the operation time, blood loss, and surgical outcomes.

Conclusion: Lap-revision is a feasible and effective method for the treatment of BA and might herald a new era for the treatment of this disease.

No MeSH data available.


Related in: MedlinePlus

(a) During laparoscopic revision of Kasai portoenterostomy, little adhesion was found around the porta hepatis after the laparoscopic Kasai portoenterostomy. (b) Redissection of the hilar plate during laparoscopic revision of Kasai portoenterostomy. PV: portal vein. (c) The fibrous tissue is transected at the hilar plate before baring the liver parenchyma. The fibrous tissue must not be completely resected and must be held lightly on the hilar plate. (d) End-to-end portoenterostomy is completed laparoscopically after trimming the Roux limb.
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fig1: (a) During laparoscopic revision of Kasai portoenterostomy, little adhesion was found around the porta hepatis after the laparoscopic Kasai portoenterostomy. (b) Redissection of the hilar plate during laparoscopic revision of Kasai portoenterostomy. PV: portal vein. (c) The fibrous tissue is transected at the hilar plate before baring the liver parenchyma. The fibrous tissue must not be completely resected and must be held lightly on the hilar plate. (d) End-to-end portoenterostomy is completed laparoscopically after trimming the Roux limb.

Mentions: In Lap-revision, the ports are placed as in Lap-Kasai without an additional skin incision. During Lap-revision, little adhesion was found around the porta hepatis in all patients after Lap-Kasai (Figure 1(a)). After intraoperative peritoneal adhesiolysis, the anastomosed Roux limb is completely dissected adjacent to the porta hepatis. To avoid unexpected excessive bleeding, the tissues are carefully manupulated using 3-mm forceps and 5-mm microbipolar forceps. The newly developed fibrous extrahepatic tissue is removed (Figure 1(b)) and the hilar plate is superficially dissected just before baring the liver parenchyma (Figure 1(c)). End-to-end portoenterostomy is performed laparoscopically after trimming the tail of the Roux limb (Figure 1(d)).


A New Era of Laparoscopic Revision of Kasai Portoenterostomy for the Treatment of Biliary Atresia.

Murase N, Uchida H, Ono Y, Tainaka T, Yokota K, Tanano A, Shirota C, Shirotsuki R - Biomed Res Int (2015)

(a) During laparoscopic revision of Kasai portoenterostomy, little adhesion was found around the porta hepatis after the laparoscopic Kasai portoenterostomy. (b) Redissection of the hilar plate during laparoscopic revision of Kasai portoenterostomy. PV: portal vein. (c) The fibrous tissue is transected at the hilar plate before baring the liver parenchyma. The fibrous tissue must not be completely resected and must be held lightly on the hilar plate. (d) End-to-end portoenterostomy is completed laparoscopically after trimming the Roux limb.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4525460&req=5

fig1: (a) During laparoscopic revision of Kasai portoenterostomy, little adhesion was found around the porta hepatis after the laparoscopic Kasai portoenterostomy. (b) Redissection of the hilar plate during laparoscopic revision of Kasai portoenterostomy. PV: portal vein. (c) The fibrous tissue is transected at the hilar plate before baring the liver parenchyma. The fibrous tissue must not be completely resected and must be held lightly on the hilar plate. (d) End-to-end portoenterostomy is completed laparoscopically after trimming the Roux limb.
Mentions: In Lap-revision, the ports are placed as in Lap-Kasai without an additional skin incision. During Lap-revision, little adhesion was found around the porta hepatis in all patients after Lap-Kasai (Figure 1(a)). After intraoperative peritoneal adhesiolysis, the anastomosed Roux limb is completely dissected adjacent to the porta hepatis. To avoid unexpected excessive bleeding, the tissues are carefully manupulated using 3-mm forceps and 5-mm microbipolar forceps. The newly developed fibrous extrahepatic tissue is removed (Figure 1(b)) and the hilar plate is superficially dissected just before baring the liver parenchyma (Figure 1(c)). End-to-end portoenterostomy is performed laparoscopically after trimming the tail of the Roux limb (Figure 1(d)).

Bottom Line: If Kasai is unsuccessful, there is controversy over whether revision of Kasai restores adequate biliary drainage.The bilirubin level was normalized by Lap-revision in all four patients, and three of them were alive with their native liver.Lap-revision is a feasible and effective method for the treatment of BA and might herald a new era for the treatment of this disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya 466-8550, Japan.

ABSTRACT

Purpose: Kasai portoenterostomy is the standard therapy for biliary atresia (BA). If Kasai is unsuccessful, there is controversy over whether revision of Kasai restores adequate biliary drainage. Although there are several reports of laparoscopic Kasai (Lap-Kasai), none has described laparoscopic revision (Lap-revision). The purposes of this study were to evaluate the feasibility and efficacy of Lap-revision.

Methods: 65 patients underwent open Kasai between November 2001 and November 2013, and 12 patients underwent Lap-Kasai between December 2013 to January 2015. The indications for revision included bile flow cessation and recurrent cholangitis. Clinical data were compared between open and laparoscopic revisions of Kasai.

Results: Open revision of Kasai was performed in 20 patients after open Kasai, and Lap-revision was performed in 4 patients after Lap-Kasai. Lap-revision was completed without conversion or major complication in any patient. The bilirubin level was normalized by Lap-revision in all four patients, and three of them were alive with their native liver. Open and laparoscopic revisions of Kasai were comparable in terms of the operation time, blood loss, and surgical outcomes.

Conclusion: Lap-revision is a feasible and effective method for the treatment of BA and might herald a new era for the treatment of this disease.

No MeSH data available.


Related in: MedlinePlus