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.
Similar content being viewed by others
References
Sasaki H, Tanaka H, Nio M (2017) Current management of long-term survivors of biliary atresia: over 40 years of experience in a single center and review of the literature. Pediatr Surg Int 33:1327–1333. https://doi.org/10.1007/s00383-017-4163-7
Ueno T, Kodama T, Noguchi Y, Saka R, Takama Y, Tazuke Y, Bessho K, Okuyama H (2018) Clinical implications of serum Mac-2-binding protein (M2BPGi) during regular follow-up of patients with biliary atresia. Pediatr Surg Int 34:1065–1071. https://doi.org/10.1007/s00383-018-4317-2
Okazaki T, Kobayashi H, Yamataka A, Lane GJ, Miyano T (1999) Long-term postsurgical outcome of biliary atresia. J Pediatr Surg 34:312–315
Nio M, Wada M, Sasaki H, Kazama T, Tanaka H, Kudo H (2016) Technical standardization of Kasai portoenterostomy for biliary atresia. J Pediatr Surg 51:2105–2108. https://doi.org/10.1016/j.jpedsurg.2016.09.047
Yanagi Y, Yoshimaru K, Matsuura T, Shibui Y, Kohashi K, Takahashi Y, Obata S, Sozaki R, Izaki T, Taguchi T (2019) The outcome of real-time evaluation of biliary flow using near-infrared fluorescence cholangiography with Indocyanine green in biliary atresia surgery. J Pediatr Surg 54:2574–2578. https://doi.org/10.1016/j.jpedsurg.2019.08.029
Suruga K, Kono S, Miyano T, Kitahara T, Soul-Chin C (1976) Treatment of biliary atresia: microsurgery for hepatic portoenterostomy. Surgery 80:558–562
Suruga K, Miyano T, Kimura K, Arai T, Kojima Y (1982) Reoperation in the treatment of biliary atresia. J Pediatr Surg 17:1–6. https://doi.org/10.1016/s0022-3468(82)80315-1
Suruga K (1981) Microsurgery for hepatic portoenterostomy in cases of biliary atresia. Ann Acad Med Singapore 10:427–433
Nakamura H, Murase N, Koga H, Cazares J, Lane GJ, Uchida H, Yamataka A (2016) Classification of biliary atresia in the laparoscopic era. Pediatr Surg Int 32:1209–1212. https://doi.org/10.1007/s00383-016-3973-3
Ure BM, Kuebler JF, Schukfeh N, Engelmann C, Dingemann J, Petersen C (2011) Survival with the native liver after laparoscopic versus conventional kasai portoenterostomy in infants with biliary atresia: a prospective trial. Ann Surg 253:826–830. https://doi.org/10.1097/SLA.0b013e318211d7d8
Wong KK, Chung PH, Chan KL, Fan ST, Tam PK (2008) Should open Kasai portoenterostomy be performed for biliary atresia in the era of laparoscopy? Pediatr Surg Int 24:931–933. https://doi.org/10.1007/s00383-008-2190-0
Wang Y, Zhang Y, Wang H, Wang T, Xia S, Chen W, Li B (2019) Learning Curve Analysis of Open Kasai Portoenterostomy for Biliary Atresia. J Surg Res 239:38–43. https://doi.org/10.1016/j.jss.2019.01.029
McKiernan PJ, Baker AJ, Kelly DA (2000) The frequency and outcome of biliary atresia in the UK and Ireland. Lancet 355:25–29. https://doi.org/10.1016/S0140-6736(99)03492-3
Nakamura H, Kawano T, Yoshizawa K, Nakajima H, Suda K, Koga H, Nakame K, Ieiri S, Takamizawa S, Urushihara N, Yanai T, Yamataka A (2016) Long-term follow-up for anicteric survival with native liver after redo Kasai: a first report. J Pediatr Surg 51:2109–2112. https://doi.org/10.1016/j.jpedsurg.2016.09.049
Shirota C, Uchida H, Ono Y, Murase N, Tainaka T, Yokota K, Oshima K, Shirotsuki R, Hinoki A, Ando H (2016) Long-term outcomes after revision of Kasai portoenterostomy for biliary atresia. J Hepato-biliary Pancreat Sci 23:715–720. https://doi.org/10.1002/jhbp.395
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ueno, T., Kodama, T., Noguchi, Y. et al. Effect of microscopy-assisted portoenterostomy (MAPE) for biliary atresia. Pediatr Surg Int 37, 223–228 (2021). https://doi.org/10.1007/s00383-020-04794-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-020-04794-x