Laparoscopic Kasai Portoenterostomy – Technical Challenges, Modifications, and Outcomes

Introduction: Laparoscopic Kasai operation stands as one of the most intricate laparoscopic procedures and its efficacy in treating biliary atresia remains a subject of controversy till date. We have performed five laparoscopic Kasai procedures and here we describe the technical modifications and our initial results. Materials and Methods: We performed a retrospective analysis of a total of five cases of biliary atresia performed laparoscopically over the last 5 years at our institution. We have used three ports and indocyanine green guidance for determining the accurate extent and depth of dissection of the fibrous portal plate. Results: All patients undergoing laparoscopic Kasai Portoenterostomy had a smooth postoperative transit. The mean total bilirubin at 6 months’ follow-up was 2.33 mg/dl (0.5–4.5 mg/dl). Two patients were anicteric on the most recent postoperative visit. Laparoscopic Kasai porto-enterostomy is recognized for minimizing blood loss, reducing the need for opioids and for causing lesser adhesions at the porta thereby making future liver transplantation comparatively easy. Conclusion: We conclude that although laparoscopic Kasai porto-enterostomy is a technically challenging procedure, however, it can safely be performed by experienced laparoscopic pediatric surgeons.