[Laparoscopic Kasai portoenterostomy in children with biliary atresia in Central Asia: outcomes, learning curve and risk factors].

OBJECTIVE

To evaluate technical feasibility, early clinical outcomes, learning curve, and risk factors affecting native liver preservation after laparoscopic Kasai portoenterostomy in children with biliary atresia in Uzbekistan.

MATERIAL AND

METHODS

A retrospective single-center study involved 33 patients with BA who underwent laparoscopic Kasai portoenterostomy between July 2022 and January 2025. Demographic data, disease characteristics, native liver survival rates, incidence of cholangitis, mortality, and the need for subsequent transplantation were assessed. Data analysis included logistic regression, CUSUM, and Kaplan-Meier methods.

RESULTS

The median age was 69 (27-148) days. Overall survival with native liver was 54.5%, patient survival - 84.8%. The incidence of postoperative cholangitis was 51.5%, and this event was an independent prognostic factor of native liver loss (odds ratio [OR] 0.035; p=0.010). The learning curve stabilized after 16-17 cases that was accompanied by shorter surgery time and better technical performance. Conversion to open surgery was required in only one case (3%).

CONCLUSION

Laparoscopic Kasai portoenterostomy is a technically feasible and effective alternative to open Kasai procedure with comparable survival rates with native liver. High incidence of cholangitis remains an important issue requiring optimization of postoperative management. In the absence of pediatric liver transplantation in Uzbekistan, improving surgical techniques and preventing cholangitis are essential to improve long-term outcomes.