LAPAROSCOPIC VERSUS OPEN KASAI PORTOENTEROSTOMY FOR BILIARY ATRESIA: A SYSTEMATIC REVIEW AND META-ANALYSIS BY THE PEDIATRIC SURGERY META-ANALYSIS STUDY GROUP (PESMA)

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.