Title: Impact of laparoscopic Kasai portoenterostomy on long-term native liver survival in patients with biliary atresia: a multicentre propensity score-matched study
Source: Hepatobiliary Surgery and Nutrition 2025
Date of publication: December 2025
Publication type: Retrospective review
Abstract: Background: Biliary atresia (BA) is a challenging disorder in paediatric surgery. This study evaluated the role of laparoscopic Kasai portoenterostomy (KPE) and steroid therapy in mid- and long-term native liver survival (NLS) in patients with BA.
Methods: Patients with BA who underwent KPE at four tertiary paediatric surgical centres between January 2000 and December 2022 were retrospectively reviewed. Jaundice clearance and NLS rates were compared between open and laparoscopic KPE groups using propensity score matching (PSM). Factors contributing to jaundice clearance and liver transplantation (LT) were analysed using multiple regression analysis.
Results: The study included 356 patients with BA, with a median follow-up of 13 years. Laparoscopy achieved a significantly higher jaundice clearance rate than the open approach in PSM cases (81%vs.64%, P=0.03). The 5-year restricted mean survival time (RMST) was not significantly different between the laparoscopic and open groups (44.7vs.40.0 months, P=0.23). Potential significant contributors to differences in 5-year RMST were the total prednisolone dosage (−0.13 months, P<0.001) and age at KPE (−0.18 months, P=0.04). Cox regression analysis stratified by age at KPE showed that a total prednisolone dosage of >90 mg/kg was associated with an increased risk of LT (hazard ratio =1.70, 95% confidence interval: 1.22–2.38, P=0.002). Laparoscopy was associated with jaundice clearance in multiple regression analysis.
Conclusions: Laparoscopy contributed to improving jaundice clearance; however, the 5-year RMST was comparable to that of the open approach. A higher total dose of prednisolone (>90 mg/kg) was associated with LT and did not improve the NLS.
