Laparoscopic Kasai portoenterostomy for biliary atresia: first experience from Central Asia

Abstract

Objective: Biliary atresia (BA) is a progressive fibro-obliterative disease of the extrahepatic bile ducts. Laparoscopic Kasai portoenterostomy (LKPE) has emerged as a minimally invasive alternative to the open approach. We aimed to evaluate the feasibility, perioperative outcomes, and early prognostic factors of LKPE in a single center. Methods: We conducted a retrospective single-center study. Feasibility, operative metrics (including the learning curve), incidence of cholangitis, native liver survival, and clinical outcomes were assessed using standard statistical methods. Results: Among the 33 patients (14 females, 19 males), the age at surgery was <60 days (12 patients), 60–89 days (13 patients), and >90 days (8 patients). The median operative time was 240 min, showing a declining trend with increasing experience. One conversion (1/33) to open surgery was required due to inadequate hilar visualization. Postoperative cholangitis occurred in 51.5% of cases and was associated with an increased risk of native liver failure (HR = 3.6, p = 0.051). The native liver survival rate at study completion was 54.5%, with 5 patients (15.2%) requiring liver transplantation. The overall mortality rate was 30.3%, primarily due to sepsis and cholangitis-related complications. Conclusions: LKPE is a feasible and effective surgical option for biliary atresia. Despite its advantages, including enhanced hilar visualization and faster recovery, the high incidence of postoperative cholangitis remains a major challenge that adversely affects native liver survival. Optimizing perioperative management, implementing prophylactic strategies against cholangitis, and expanding pediatric liver transplantation programs in resource-limited settings are essential to improving outcomes. Further prospective studies with long-term follow-up are needed to refine surgical techniques and optimize patient management.