Expert Committee on Pediatric Endoscopy,National Health Commission,Branch of Medical Robotic Surgeon,et al.Expert Consensus on Diagnosing Biliary Atresia and Kasai Surgery Based Upon Endoscopic Technology (Edition 2025)[J].Journal of Clinical Pediatric Surgery,,():713-720.[doi:10.3760/cma.j.cn101785-202410003-003]
Expert Consensus on Diagnosing Biliary Atresia and Kasai Surgery Based Upon Endoscopic Technology (Edition 2025)
- Keywords:
- Biliary Atresia; Diagnosis; Operative Laparoscopy; Robotic Surgical Procedures; Kasai Surgery; Expert Consensus
- Abstract:
- In the clinical practices of surgery,technology continues to drive innovation in diagnostic and surgical modalities.Laparoscopic technique plays a more and more important role in the diagnosis and treatment of biliary atresia (BA).As one of the more groundbreaking innovations,da Vinci robotic surgical system not only changes the way surgery is performed,but also opens up new therapeutic options for BA.Robotic-assisted Kasai portoenterostomy,as a treatment option for BA,has achieved improved efficacy as compared to laparoscopy.To standardize the clinical practices,guarantee the quality of diagnosis and treatment,promote a healthy development of laparoscopic/robotic-assisted BA surgery,Expert Committee of Pediatric Endoscopy of National Health Commission and Medical Robotic Surgeon Branch of Chinese Medical Doctor Association have formulated the Expert Consensus.It focused upon laparoscopic-assisted BA diagnosis,indications and contraindications of laparoscopic/robotic-assisted Kasai portoenterostomy,surgical approaches and key surgical procedures.
References:
[1] Chung PHY,Zheng S,Tam PKH.Biliary atresia:east versus west[J].Semin Pediatr Surg,2020,29(4):150950.DOI:10.1016/j.sempedsurg.2020.150950.
[2] Kasai M,Sawaguchi S,Akiyama T,et al.A proposal of new classification of biliary atresia[J].J Jpn Soc Pediatr Surg,1976,12(2):327-331.DOI:10.11164/jjsps.12.2_327.
[3] Davenport M.Biliary atresia:clinical aspects[J].Semin Pediatr Surg,2012,21(3):175-184.DOI:10.1053/j.sempedsurg.2012.05.010.
[4] Senyüz OF,Ye?ilda? E,Emir H,et al.Diagnostic laparoscopy in prolonged jaundice[J].J Pediatr Surg,2001,36(3):463-465.DOI:10.1053/jpsu.2001.21621.
[5] Esteves E,Clemente Neto E,Ottaiano Neto M,et al.Laparoscopic Kasai portoenterostomy for biliary atresia[J].Pediatr Surg Int,2002,18(8):737-740.DOI:10.1007/s00383-002-0791-6.
[6] Takeda M,Sakamoto S,Uchida H,et al.Comparative study of open and laparoscopic Kasai portoenterostomy in children undergoing living donor liver transplantation for biliary atresia[J].Pediatr Surg Int,2021,37(12):1683-1691.DOI:10.1007/s00383-021-04994-z.
[7] 李龙,刘雪来,谷奇,等.腹腔镜肝门空肠吻合手术治疗胆道闭锁的探讨[J].中华小儿外科杂志,2006,27(4):212-213.DOI:10.3760/cma.j.issn.0253-3006.2006.04.013. Li L,Liu XL,Gu Q,et al.Discussion on laparoscopic hepatoportojejunostomy in the treatment of biliary atresia[J].Chin J Pediatr Surg,2006,27(4):212-213.DOI:10.3760/cma.j.issn.0253-3006.2006.04.013.
[8] Meehan JJ,Elliott S,Sandler A.The robotic approach to complex hepatobiliary anomalies in children:preliminary report[J].J Pediatr Surg,2007,42(12):2110-2114.DOI:10.1016/j.jpedsurg.2007.08.040.
[9] Zhang MX,Cao GQ,Li XY,et al.Robotic-assisted Kasai portoenterostomy for biliary atresia[J].Surg Endosc,2023,37(5):3540-3547.DOI:10.1007/s00464-022-09855-x.
[10] Hay SA,Soliman HE,Sherif HM,et al.Neonatal jaundice:the role of laparoscopy[J].J Pediatr Surg,2000,35(12):1706-1709.DOI:10.1053/jpsu.2000.19217.
[11] Bezerra JA,Wells RG,Mack CL,et al.Biliary atresia:clinical and research challenges for the twenty-first century[J].Hepatology,2018,68(3):1163-1173.DOI:10.1002/hep.29905.
[12] Okazaki T,Ochi T,Nakamura H,et al.Needle liver biopsy has potential for delaying Kasai portoenterostomy and is obsolete for diagnosing biliary atresia in the laparoscopic era[J].J Pediatr Surg,2019,54(12):2570-2573.DOI:10.1016/j.jpedsurg.2019.08.028.
[13] Tagawa M,Morita A,Imagawa K,et al.Endoscopic retrograde ch-olangiopancreatography and endoscopic ultrasound in children[J].Dig Endosc,2021,33(7):1045-1058.DOI:10.1111/den.13928.
[14] Siles P,Aschero A,Gorincour G,et al.A prospective pilot study:can the biliary tree be visualized in children younger than 3 months on Magnetic Resonance Cholangiopancreatography?[J].Pediatr Radiol,2014,44(9):1077-1084.DOI:10.1007/s00247-014-2953-9.
[15] Tang ST,Li SW,Ying Y,et al.The evaluation of laparoscopy-assisted cholangiography in the diagnosis of prolonged jaundice in infants[J].J Laparoendosc Adv Surg Tech A,2009,19(6):827-830.DOI:10.1089/lap.2008.0432.
[16] Hirsig J,Rickham PP.Early differential diagnosis between neonatal hepatitis and biliary atresia[J].J Pediatr Surg,1980,15(1):13-15.DOI:10.016/s0022-3468(80)80394-0.
[17] Yang L,Zhou Y,Xu PP,et al.Diagnostic accuracy of serum matrix metalloproteinase-7 for biliary atresia[J].Hepatology,2018,68(6):2069-2077.DOI:10.1002/hep.30234.
[18] Pandurangi S,Mourya R,Nalluri S,et al.Diagnostic accuracy of serum matrix metalloproteinase-7 as a biomarker of biliary atresia in a large North American cohort[J].Hepatology,2024,80(1):152-162.DOI:10.1097/HEP.0000000000000827.
[19] Chi SQ,Xu PP,Yu P,et al.Dynamic analysis of serum MMP-7 and its relationship with disease progression in biliary atresia:a multicenter prospective study[J].Hepatol Int,2022,16(4):954-963.DOI:10.1007/s12072-022-10322-x.
[20] Chang XP,Chi SQ,Zhang X,et al.Inhibition of Notch3/Hey1 ameliorates peribiliary hypoxia by preventing hypertrophic hepatic arteriopathy in biliary atresia progression[J].Histochem Cell Biol,2024,161(6):461-476.DOI:10.1007/s00418-024-02278-w.
[21] Li YB,Rong LY,Tang JF,et al.Re-evaluation of laparoscopic hepatic subcapsular spider-like telangiectasis sign:a highly accurate method to diagnose biliary atresia in infants[J].Front Pediatr,2022,10:850449.DOI:10.3389/fped.2022.850449.
[22] Pesce A,Piccolo G,La Greca G,et al.Utility of fluorescent cholangiography during laparoscopic cholecystectomy:a systematic review[J].World J Gastroenterol,2015,21(25):7877-7883.DOI:10.3748/wjg.v21.i25.7877.
[23] Hirayama Y,Iinuma Y,Yokoyama N,et al.Near-infrared fluorescence cholangiography with indocyanine green for biliary atresia.Real-time imaging during the Kasai procedure:a pilot study[J].Pediatr Surg Int,2015,31(12):1177-1182.DOI:10.1007/s00383-015-3799-4.
[24] Zhao JW,Zhao Y,Zhang YN,et al.Preliminary exploration of the efficacy of laparoscopic fluorescence cholangiography (LFC) in the diagnosis of biliary atresia compared with intraoperative cholangiography (IOC)[J].Photodiagnosis Photodyn Ther,2023,41:103241.DOI:10.1016/j.pdpdt.2022.103241.
[25] Wang MR,Liao JM,Li SS,et al.Laparoscopic indocyanine green fluorescence imaging technique in rare type II cystic biliary atresia[J].Photodiagnosis Photodyn Ther,2023,44:103846.DOI:10.1016/j.pdpdt.2023.103846.
[26] Cazares J,Koga H,Murakami H,et al.Laparoscopic portoenterostomy for biliary atresia:single-center experience and review of literatures[J].Pediatr Surg Int,2017,33(12):1341-1354.DOI:10.1007/s00383-017-4171-7.
[27] Ji Y,Yang KY,Zhang XP,et al.The short-term outcome of modified laparoscopic Kasai portoenterostomy for biliary atresia[J].Surg Endosc,2021,35(3):1429-1434.DOI:10.1007/s00464-020-07530-7.
[28] Sun X,Diao M,Wu XZ,et al.A prospective study comparing laparoscopic and conventional Kasai portoenterostomy in children with biliary atresia[J].J Pediatr Surg,2016,51(3):374-378.DOI:10.1016/j.jpedsurg.2015.10.045.
[29] Murase N,Uchida H,Ono Y,et al.A new era of laparoscopic revision of Kasai portoenterostomy for the treatment of biliary atresia[J].Biomed Res Int,2015,2015:173014.DOI:10.1155/2015/173014.
[30] Yamataka A,Lane GJ,Cazares J.Laparoscopic surgery for biliary atresia and choledochal cyst[J].Semin Pediatr Surg,2012,21(3):201-210.DOI:10.1053/j.sempedsurg.2012.05.011.
[31] Wang B,Feng Q,Ye XS,et al.The experience and technique in laparoscopic portoenterostomy for biliary atresia[J].J Laparoendosc Adv Surg Tech A,2014,24(5):350-353.DOI:10.1089/lap.2013.0138.
[32] Li B,Chen WB,Huang X,et al.Modifications to expose porta hepatis for laparoscopic portoenterostomy easier in biliary atresia[J].J Surg Res,2019,233:368-375.DOI:10.1016/j.jss.2018.08.013.
[33] Nio M,Wada M,Sasaki H,et al.Technical standardization of Kasai portoenterostomy for biliary atresia[J].J Pediatr Surg,2016,51(12):2105-2108.DOI:10.1016/j.jpedsurg.2016.09.047.
[34] Bove KE,Thrasher AD,Anders R,et al.Inflammation,active fibroplasia,and end-stage fibrosis in 172 biliary atresia remnants correlate poorly with age at Kasai portoenterostomy,visceral heterotaxy,and outcome[J].Am J Surg Pathol,2018,42(12):1625-1635.DOI:10.1097/PAS.0000000000001146.
[35] Yamataka A,Kato Y,Miyano T.Biliary tract disorders and portal hypertension[M].Philadelphia:W.B.Saunders,2010:557-577.
[36] 董淳强,董昆,张诚,等.保留肝门部纤维板和肝肠浅缝吻合在Kasai手术的应用[J].临床小儿外科杂志,2016,15(1):14-19.DOI:10.3969/j.issn.1671-6353.2016.01.005. Dong CQ,Dong K,Zhang C,et al.Technique of preserving fibrosis plate and shallow suturing during Kasai portoenterostomy[J].J Clin Ped Sur,2016,15(1):14-19.DOI:10.3969/j.issn.1671-6353.2016.01.005.
[37] Abe E,Koga H,Nakamura H,et al.Mid-term outcome of postoperative biliary atresia patients according to level of transection of the biliary remnant and depth of suturing[J].Pediatr Surg Int,2022,38(5):701-706.DOI:10.1007/s00383-022-05097-z.
[38] Huang SY,Yeh CM,Chen HC,et al.Reconsideration of laparoscopic Kasai operation for biliary atresia[J].J Laparoendosc Adv Surg Tech A,2018,28(2):229-234.DOI:10.1089/lap.2017.0535.
[39] 张震,乔国梁,叶茂,等.腹腔镜与开放Kasai手术治疗Ⅲ型胆道闭锁中期疗效的对比[J].临床小儿外科杂志,2016,15(2):156-158.DOI:10.3969/j.issn.1671-6353.2016.02.015. Zhang Z,Qiao GL,Ye M,et al.Laparoseopic versus open Kasai operation on mid-term outcomes of infants with type Ⅲ biliary atresia[J].J Clin Ped Sur,2016,15(2):156-158.DOI:10.3969/j.issn.1671-6353.2016.02.015.
[40] Nakamura H,Koga H,Wada M,et al.Reappraising the portoenterostomy procedure according to sound physiologic/anatomic principles enhances postoperative jaundice clearance in biliary atresia[J].Pediatr Surg Int,2012,28(2):205-209.DOI:10.1007/s00383-011-3019-9.
[41] Koga H,Miyano G,Takahashi T,et al.Laparoscopic portoenterostomy for uncorrectable biliary atresia using Kasai’s original technique[J].J Laparoendosc Adv Surg Tech A,2011,21(3):291-294.DOI:10.1089/lap.2010.0162.
[42] Nakamura H,Koga H,Miyano G,et al.Does the level of transection of the biliary remnant affect outcome after laparoscopic Kasai portoenterostomy for biliary atresia?[J].J Laparoendosc Adv Surg Tech A,2017,27(7):744-747.DOI:10.1089/lap.2016.0202.
[43] Madadi-Sanjani O,Petersen C,Ure B.Minimally invasive hepatobiliary surgery[J].Clin Perinatol,2017,44(4):805-818.DOI:10.1016/j.clp.2017.08.004.
[44] Dutta S,Woo R,Albanese CT.Minimal access portoenterostomy:advantages and disadvantages of standard laparoscopic and robotic techniques[J].J Laparoendosc Adv Surg Tech A,2007,17(2):258-264.DOI:10.1089/lap.2006.0112.
[45] Decharun K,Leys CM,West KW,et al.Prophylactic antibiotics for prevention of cholangitis in patients with biliary atresia status post-Kasai portoenterostomy:a systematic review[J].Clin Pediatr (Phila),2016,55(1):66-72.DOI:10.1177/0009922815594760.
[46] Calinescu AM,Madadi-Sanjani O,Mack C,et al.Cholangitis definition and treatment after Kasai hepatoportoenterostomy for biliary atresia:a Delphi process and international expert panel[J].J Clin Med,2022,11(3):494.DOI:10.3390/jcm11030494.
[47] Calinescu AM,Wilde JCH,Korff S,et al.Perioperative complications after Kasai hepatoportoenterostomy:data from the Swiss National Biliary Atresia Registry[J].Eur J Pediatr Surg,2020,30(4):364-370.DOI:10.1055/s-0039-1692686.
[48] Tainaka T,Kaneko K,Seo T,et al.Intrahepatic cystic lesions after hepatic portoenterostomy for biliary atresia with bile lake and dilated bile ducts[J].J Pediatr Gastroenterol Nutr,2007,44(1):104-107.DOI:10.1097/01.mpg.0000237930.45846.ae.
[49] Goda T,Kubota A,Kawahara H,et al.The clinical significance of intrahepatic cystic lesions in postoperative patients with biliary atresia[J].Pediatr Surg Int,2012,28(9):865-868.DOI:10.1007/s00383-012-3149-8.
Memo
收稿日期:2024-10-4。
基金项目:国家卫生健康委员会2014年度公益性行业科研专项项目(201402007)
通讯作者:汤绍涛,Email:tshaotao83@126.com;王斌,Email:szwb1967@126.com;李索林,Email:lisuolin@263.net