Comparison between robotic-assisted Kasai portoenterostomy and open Kasai portoenterostomy in patients with biliary atresia

Surg Endosc. 2024 Nov 15. doi: 10.1007/s00464-024-11385-7. Online ahead of print.

Abstract

Background: Robotic-assisted Kasai portoenterostomy (RAKPE) is regarded as a treatment option for patients with biliary atresia (BA). We aimed to compare the clinical outcomes of RAKPE to the open Kasai portoenterostomy (OKPE).

Methods: A retrospective review was conducted on a total of 74 type III BA patients who underwent RAKPE (RA group, n = 36) or OKPE (OP group, n = 38) from January 2018 to December 2022. The study analyzed demographic characteristics, intraoperative findings, and postoperative outcomes.

Results: The operative time in the RA group was significantly longer than that in the OP group (218.61 ± 31.70 min vs 178.50 ± 27.90 min, P < 0.05). The estimated blood loss in RA group was significantly lower than that in the OP group (8.65 ± 2.30 mL vs 17.55 ± 3.60 mL, P < 0.05). The recovery time of bowel sounds was significantly shorter in RA group than in the OP group (0.96 ± 0.12 days vs 2.84 ± 0.37 days, P < 0.05). All patients had bile-stained stools within 1-3 days after surgery. The clearance rate of jaundice at 3 and 6 months were significantly higher in RA group than in OP group (69.44% vs 60.53%, 75.00% vs 68.42%, P < 0.05). The rate of cholangitis in RA group was similar to that in OP group (50.00% vs 52.63%, P > 0.05). The native liver survival rate during the follow-up period was comparable between two groups (66.67% vs 63.16%, P > 0.05).

Conclusion: Robotic-assisted Kasai surgery offers advantages in short-term outcomes and the clearance of jaundice in patients with type III BA.

Keywords: Biliary atresia; Kasai portoenterostomy surgery; Outcomes; Robotic assisted.