Technique and early outcomes of total laparoscopic Kasai portoenterostomy in Type III biliary atresia

PURPOSE: To evaluate the early outcomes of total laparoscopic Kasai portoenterostomy (TL-KPE) for Type III biliary atresia (BA). METHODS: A retrospective analysis included 45 pediatric patients with Type III BA who underwent Kasai portoenterostomy between January 2018 and December 2024. Patients were divided into three groups (n = 15 each): open KPE (O-KPE), conventional laparoscopic KPE (L-KPE, with extracorporeal intestinal anastomosis), and TL-KPE (with fully intracorporeal anastomosis). Comparative parameters included operative time, intraoperative blood loss, postoperative recovery metrics, incidence of cholangitis within 6 months, jaundice clearance, and native liver survival rates. RESULTS: Compared with the O-KPE group, the TL-KPE group showed significantly less intraoperative blood loss (P = 0.016). Compared with both the O-KPE and L-KPE groups, the TL-KPE group had markedly shorter time to bowel recovery and postoperative fasting time (all P < 0.001). Postoperative hospital stay was also significantly shorter in the TL-KPE group compared to the O-KPE (P = 0.016) and L-KPE (P = 0.034) groups. There were no significant differences among the three groups in operative time (P = 0.052), incidence of postoperative complications (P = 0.132), jaundice clearance cases (P = 0.278), early cholangitis (P = 0.932), or recurrent cholangitis (P = 1.000). No perioperative deaths occurred in any group. CONCLUSION: TL-KPE is a safe and technically feasible approach for Type III BA that enhances short-term postoperative recovery. These early results warrant further multicenter prospective studies with longer follow-up to evaluate potential long-term benefits on native liver survival.