# A New Era of Laparoscopic Revision of Kasai Portoenterostomy for the Treatment of Biliary Atresia

## TL;DR

This study shows that laparoscopic revision of Kasai surgery is a safe and effective treatment for biliary atresia when the initial surgery fails.

## Contribution

The paper introduces and validates laparoscopic revision of Kasai portoenterostomy, a previously unreported technique.

## Key findings

- Lap-revision was completed without conversion or major complications in all four patients.
- Bilirubin levels were normalized in all four patients who underwent Lap-revision.
- Three patients who had Lap-revision were alive with their native liver.

## Abstract

Purpose. Kasai portoenterostomy is the standard therapy for biliary atresia (BA). If Kasai is unsuccessful, there is controversy over whether revision of Kasai restores adequate biliary drainage. Although there are several reports of laparoscopic Kasai (Lap-Kasai), none has described laparoscopic revision (Lap-revision). The purposes of this study were to evaluate the feasibility and efficacy of Lap-revision. Methods. 65 patients underwent open Kasai between November 2001 and November 2013, and 12 patients underwent Lap-Kasai between December 2013 to January 2015. The indications for revision included bile flow cessation and recurrent cholangitis. Clinical data were compared between open and laparoscopic revisions of Kasai. Results. Open revision of Kasai was performed in 20 patients after open Kasai, and Lap-revision was performed in 4 patients after Lap-Kasai. Lap-revision was completed without conversion or major complication in any patient. The bilirubin level was normalized by Lap-revision in all four patients, and three of them were alive with their native liver. Open and laparoscopic revisions of Kasai were comparable in terms of the operation time, blood loss, and surgical outcomes. Conclusion. Lap-revision is a feasible and effective method for the treatment of BA and might herald a new era for the treatment of this disease.