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. 2021 Feb;37(2):223-228.
doi: 10.1007/s00383-020-04794-x. Epub 2021 Jan 2.

Effect of microscopy-assisted portoenterostomy (MAPE) for biliary atresia

Takehisa Ueno  1 , Tasuku Kodama  2 , Yuki Noguchi  2 , Motonari Nomura  2 , Ryuta Saka  2 , Yuichi Takama  2 , Yuko Tazuke  2 , Kazuhiko Bessho  3 , Hiroomi Okuyama  2
Affiliations

Effect of microscopy-assisted portoenterostomy (MAPE) for biliary atresia

Takehisa Ueno et al. Pediatr Surg Int. 2021 Feb.

Abstract

Purpose: Portoenterostomy (PE) is the standard treatment for biliary atresia (BA). However, micro-bile ducts are difficult to identify with surgical loupes and dissect systematically. We report the effects of our attempts to dissect hilar tissue using a surgical microscope.

Methods: Microscopy-assisted portoenterostomy (MAPE) was initiated in 2014. Patients born between 2000 and 2013 who underwent PE until day 70 without a surgical microscope for BA were gathered as historical control. MAPE in re-do PE cases (Re-MAPE) was evaluated in the same manner.

Results: Ten patients underwent MAPE for BA during the study period. 17 patients in the conventional PE group were gathered. In the MAPE group, the jaundice clearance rate was 80%, compared with 53% in the conventional PE group. Re-MAPE was performed in four patients, who had a jaundice clearance rate of 75%, essentially identical to the rate with initial MAPE. At age 4 years, the native liver survival rate was 58% in the MAPE group and 38% in the conventional PE group. The native liver survival rate in the Re-MAPE group was 75%.

Conclusion: MAPE is useful for sharing the surgical field during open PE in patients with BA. It may improve the rate of jaundice clearance.

Keywords: Jaundice clearance; Liver transplantation; Micro-bile duct; Native liver survival.

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