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. 2024 Dec 9:12:1476195.
doi: 10.3389/fped.2024.1476195. eCollection 2024.

Laparoscopic vs. open portoenterostomy for biliary atresia: a meta-analysis of pediatric surgical outcomes

Jie Zhu  1 , Bin Wu  1 , Peng Cai  1 , Jiang Pan  1 , Zhenwei Zhu  1
Affiliations

Laparoscopic vs. open portoenterostomy for biliary atresia: a meta-analysis of pediatric surgical outcomes

Jie Zhu et al. Front Pediatr. .

Abstract

Background: The pivotal importance of surgical treatment for pediatric biliary atresia is well-established. This systematic review and meta-analysis was designed to assess the comparative efficacy and safety of open portoenterostomy (OPE) and laparoscopic portoenterostomy (LPE) in managing this condition, providing valuable guidance for clinical decision-making.

Methods: A comprehensive literature review was conducted by two researchers in databases such as PubMed, up to July 10, 2024, focusing on studies that evaluated the role of LPE vs. OPE. Data analysis was performed utilizing the RevMan 5.4 software suite.

Results: The meta-analysis incorporated findings from 15 studies involving a total of 964 pediatric patients with biliary atresia. LPE was associated with decreased intraoperative blood loss [Mean Difference (MD) = -10.80, 95% Confidence Interval (CI) (-13.54, -8.05)] and shortened hospital stay [MD = -2.18, 95% CI (-3.69, -0.67)]. Conversely, the operative time for LPE was considerably longer when compared to OPE [MD = 35.45, 95% CI (26.17, 44.72)]. No significant disparities were noted in the postoperative jaundice clearance rate [Odds Ratio (OR) = 0.98, 95% CI (0.71, 1.35)], incidence of postoperative cholangitis [OR = 0.96, 95% CI (0.66, 1.39)], the rate of liver transplantation between the two surgical approaches [OR = 0.69, 95% CI (0.32, 1.48)], or 2-year survival of the native liver [OR = 1.10, 95% CI (0.67, 1.80)].

Conclusion: LPE offers more advantages over OPE, including diminished invasiveness and expedited recovery. These benefits suggest that LPE is an emerging and viable alternative in the clinical management of biliary atresia, warranting further investigation and consideration in surgical practice.

Keywords: biliary atresia; children; laparoscopy; portoenterostomy; surgery; treatment.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study inclusion.
Figure 2
Figure 2
The forest plots for intraoperative blood loss (A), length of hospital stay (B) and duration of surgery (C) (LPE is associated with reduced intraoperative blood loss, decreased length of hospital stay but longer duration of surgery).
Figure 3
Figure 3
The forest plots for the postoperative clearance rate of jaundice (A) and incidence of postoperative cholangitis (B) (no significant differences in the postoperative clearance rate of jaundice and the incidence of postoperative cholangitis between LPE and OPE are found).
Figure 4
Figure 4
The forest plots for the rate of liver transplantation (A) and 2-year survival with the native liver (B) (no significant differences in the rate of liver transplantation and 2-year survival with the native liver between LPE and OPE are found).
Figure 5
Figure 5
The funnel plots for the intraoperative blood loss (A), the length of hospital stay (B), the duration of surgery (C), the postoperative clearance rate of jaundice (D).
Figure 6
Figure 6
The funnel plots for the synthesized outcomes. (A) Funnel plot for the incidence of postoperative cholangitis; (B) Funnel plot for the rate of liver transplantation; (C) Funnel plot for the 2-year survival with the native liver.
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References

    1. Tam PKH, Wells RG, Tang CSM, Lui VCH, Hukkinen M, Luque CD, et al. Biliary atresia. Nat Rev Dis Primers. (2024) 10(1):47. 10.1038/s41572-024-00533-x - DOI - PMC - PubMed
    1. Liu S, Li T, Yang Q, Ke X, Zhan J. Biliary atresia: the development, pathological features, and classification of the bile duct. Pediatr Surg Int. (2024) 40(1):42. 10.1007/s00383-023-05627-3 - DOI - PubMed
    1. Antala S, Taylor SA. Biliary atresia in children: update on disease mechanism, therapies, and patient outcomes. Clin Liver Dis. (2022) 26(3):341–54. 10.1016/j.cld.2022.03.001 - DOI - PMC - PubMed
    1. Amarachintha SP, Mourya R, Ayabe H, Yang L, Luo Z, Li X, et al. Biliary organoids uncover delayed epithelial development and barrier function in biliary atresia. Hepatology. (2022) 75(1):89–103. 10.1002/hep.32107 - DOI - PMC - PubMed
    1. Harpavat S, Garcia-Prats JA, Anaya C, Brandt ML, Lupo PJ, Finegold MJ, et al. Diagnostic yield of newborn screening for biliary atresia using direct or conjugated bilirubin measurements. J Am Med Assoc. (2020) 323(12):1141–50. 10.1001/jama.2020.0837 - DOI - PMC - PubMed

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