LAPAROSCOPIC VERSUS OPEN KASAI PORTOENTEROSTOMY FOR BILIARY ATRESIA: A SYSTEMATIC REVIEW AND META-ANALYSIS BY THE PEDIATRIC SURGERY META-ANALYSIS STUDY GROUP (PESMA)
Date Issued
2025-10
Author(s)
Duygu Gurel
Mustafa Azizoglu
Carlos Delgado Miguel
Federica Pederiva
Mehmet Hanifi Okur
Tahsin Onat Kamci
Sonia Perez Bertolez
Jennifer Martinez
Maria Escolino
Annika Mutanen
Abstract
Introduction: Biliary atresia (BA) is a rare but life-threatening neonatal liver disease
requiring timely surgical intervention. The Kasai portoenterostomy (KPE) is the standard
treatment, traditionally performed via laparotomy. Recently, laparoscopic approach has
been introduced, but its efficacy remains debated. This systematic review and meta-analysis
compared laparoscopic and open KPE in patients with BA.
Methods: A comprehensive literature search of PubMed, Scopus, EMBASE, and Web of
Science was conducted through April 2025. Primary outcomes were jaundice clearance,
cholangitis, overall complications, 2-year native liver survival rate, and postoperative
intestinal obstruction. Pooled odds ratios (OR) and 95% confidence intervals (CI) were
calculated using Mantel–Haenszel methods under fixed- or random-effects models, based on
heterogeneity (I²). We used RevMan 5.4 software meta-analysis statistic program.
Results: A total of 26 studies were included. Jaundice clearance (17 studies; OR=1.10;
95%CI: 0.76–1.59; p=0.61; I²=42%) and cholangitis (15 studies; OR=1.17; 95%CI: 0.87–
1.59; p=0.30; I²=0%) rates showed no significant differences between laparoscopic and open
groups. No significant differences were observed in overall complication rates (8 studies;
OR=0.71; 95%CI: 0.24–2.09; p=0.54; I²=57%). Postoperative intestinal obstruction (7
studies) and 2-year native liver survival (8 studies) also showed comparable outcomes
(OR=0.91; 95% CI: 0.36–2.27; p=0.83; I²=0% and OR=0.74; 95% CI: 0.49–1.10; p=0.13;
I²=30% respectively).
Conclusion: Laparoscopic KPE appears to be a safe and feasible alternative to the open
approach, with comparable outcomes across major clinical parameters. While current
evidence supports its feasibility, further high-quality prospective studies are needed to
validate these findings and inform surgical practice.
requiring timely surgical intervention. The Kasai portoenterostomy (KPE) is the standard
treatment, traditionally performed via laparotomy. Recently, laparoscopic approach has
been introduced, but its efficacy remains debated. This systematic review and meta-analysis
compared laparoscopic and open KPE in patients with BA.
Methods: A comprehensive literature search of PubMed, Scopus, EMBASE, and Web of
Science was conducted through April 2025. Primary outcomes were jaundice clearance,
cholangitis, overall complications, 2-year native liver survival rate, and postoperative
intestinal obstruction. Pooled odds ratios (OR) and 95% confidence intervals (CI) were
calculated using Mantel–Haenszel methods under fixed- or random-effects models, based on
heterogeneity (I²). We used RevMan 5.4 software meta-analysis statistic program.
Results: A total of 26 studies were included. Jaundice clearance (17 studies; OR=1.10;
95%CI: 0.76–1.59; p=0.61; I²=42%) and cholangitis (15 studies; OR=1.17; 95%CI: 0.87–
1.59; p=0.30; I²=0%) rates showed no significant differences between laparoscopic and open
groups. No significant differences were observed in overall complication rates (8 studies;
OR=0.71; 95%CI: 0.24–2.09; p=0.54; I²=57%). Postoperative intestinal obstruction (7
studies) and 2-year native liver survival (8 studies) also showed comparable outcomes
(OR=0.91; 95% CI: 0.36–2.27; p=0.83; I²=0% and OR=0.74; 95% CI: 0.49–1.10; p=0.13;
I²=30% respectively).
Conclusion: Laparoscopic KPE appears to be a safe and feasible alternative to the open
approach, with comparable outcomes across major clinical parameters. While current
evidence supports its feasibility, further high-quality prospective studies are needed to
validate these findings and inform surgical practice.
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