Laparoscopic Kasai Has Similar Anesthetic Outcomes to Open Kasai

Study Overview
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Brief Summary
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Biliary atresia (BA) is a rare biliary tree disease with a high incidence in eastern Asia. Kasai operation is a standard treatment for BA, and studies have shown that timely Kasai operation is crucial for better outcomes. The Kasai operation can be performed as either an open or laparoscopic technique. This study aimed to compare the differences in anesthetic management between the two surgical groups. Herein, we compared the outcomes of infants with BA who underwent the open and laparoscopic Kasai surgery.

Detailed Description
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Biliary atresia is (BA) a rare biliary tree disease. This disease, which is usually found in infancy is characterized by biliary inflammation and obliteration. The incidence variate from 1 in 5000 to 20000. However, high prevalence rate up to 1 in 5-10,000 was comparatively noted in eastern Asia, especially in Japan and Taiwan. Biliary atresia can be treated by Kasai operation ( Kasai portoenterotomy) or liver transplantation. In the previous study, 60% of biliary atresia patients after receiving Kasai portoenterostomy could have better liver prognosis.The timing of Kasai operation is also crucial, increased age of surgery had negative influence in the long-term follow up. Traditionally, Kasai portoenterostomy was performed by open surgery. As the progression and popularity of minimally invasive surgery, laparoscopic Kasai was first introduced in 2002 and then performed in many countries. However, the advantage of laparoscopic Kasai seems still controversial due to many indicative outcomes as early jaundice clearance, native liver survival (NLS) and liver transplantation rate within 1 year after the Kasai operation even adhesions prevention seems no better maybe worse in laparoscopic group.But in our hospital, no statistically significant differences were observed for hospital stay and outcomes (including early jaundice clearance rate, episodes of cholangitis, and 2-year native liver survival rate) between the open and the laparoscopic Kasai operations.Even the better operation view was noted in laparoscopic group but operation time seems almost all prolonged in laparoscopic one compared to open one, that makes excessive fluid infusion and hypothermia easily found in laparoscopic group . However, no hypothermia and laryngeal edema were noted in our hospital compare to previous study

Official Title
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Laparoscopic Kasai Portoenterostomy Has Similar Surgical Outcomes and Better Urine Output Compared to Standard Open Kasai- Portoenterostomy: A Ten-year Retrospective Cohort Study

Conditions
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Biliary Atresia

Intervention / Treatment
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* Procedure: laparoscopic


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: children who had undergone Kasai portoenterostomy between January 2011 and December 2021 Exclusion Criteria: severe congenital heart disease requiring surgical treatment, reoperation, a diagnosis of non-biliary atresia, incomplete medical records.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| O group<br>conventional Kasai portoenterostomy | |
| L group<br>laparoscopic Kasai portoenterostomy | Procedure: laparoscopic<br>* laparoscopic<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| fluid intake_1 | intravenous fluid infusion during the operation ( ml) | through study completion, an average of 1 year | 
| fluid intake_2 | transfusion volume during the operation (ml) | through study completion, an average of 1 year | 
| output_1 | urine output | through study completion, an average of 1 year | 
| output_2 | blood loss (ml) | through study completion, an average of 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| respiratory outcomes_1 | extubation time ( duration between extubation and end of the surgery) | through study completion, an average of 1 year | 
| respiratory outcomes_2 | EtCO2 | through study completion, an average of 1 year | 
| respiratory outcomes_3 | peak airway pressure | through study completion, an average of 1 year | 
| surgery duration of the surgery | total surgery time | through study completion, an average of 1 year | 
| total days of hospitalization | total hospital days | through study completion, an average of 1 year | 
| total days of admission to ICU | total ICU days | through study completion, an average of 1 year | 
| surgery-related outcomes_1 | postoperative day 1 liver function ( GOT, GPT,bilirubin in the postoperative day 1) | through study completion, an average of 1 year | 
| surgery-related outcomes_2 | native liver survival time ( duration before liver transplantation) | through study completion, an average of 1 year | 
| surgery-related outcomes_3 | cholangitis ( cholangitis needes antibiotics treatment) | through study completion, an average of 1 year | 
| surgery-related outcomes_4 | 6-month bilirubin clearance rate ( bilirubin below standard rate at 6-month) | through study completion, an average of 1 year |