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Objectives: Laparoscopic Kasai portoenterostomy (LKPE) has been shown to be a safe and feasible procedure in patients with biliary atresia (BA). The purpose of this study was to investigate the efficacy of modified LKPE (MLKPE) in the treatment of BA. Methods: Data of 58 BA patients undertaken MLPKE from July 2014 to December 2015 were retrospectively analyzed (group B), and compared with that of 43 BA patients received open Kasai portoenterostomy (OKPE) during the same period (group C). In addition, 195 BA patients who had undergone LKPE during May 2009 to June 2014 were also included (group A). Results: All 296 patients enrolled in this study were non-syndromic type III BA. Compared with group A, group B had shorter operative time (ORT) (P < 0.01) and fewer intraoperative blood transfusion (IOBT) (P < 0.05). The conversion rate and cholangitis rate were also significantly lower in group B than that in group A (P < 0.05). The postoperative oral intake resumed (POOR), any postoperative complications (APOC), clearance of jaundice (CJ), 1-year and 3-year survival rate with native liver (SNL) were not significantly different between group A and group B (P > 0.05). The ORT, IOBT, POOR, APOC, CJ, 1-year and 3-year SNL in group B were much better than that of group C (P < 0.05). Conclusion: The MLKPE was associated with good perioperative with ORT, IOBT, POOR, and APOC. The short-term outcomes in MLKPE were no worse than that of OKPE and LKPE. MLKPE can be regarded as a treatment option for BA. [ABSTRACT FROM AUTHOR]

Background: Although open portoenterostomy (OPE) is considered the standard treatment for biliary atresia (BA), laparoscopic portoenterostomy (LPE) is conducted and reported by many investigators. Data on the safety and efficacy of LPE remain controversial. The aim of this meta-analysis is to compare the safety and efficacy of LPE and OPE for the treatment of BA.Methods: Three electronic databases were searched: PubMed, Embase, and the Cochrane Library. The eligible studies were limited to those published in English. The following keywords were used: "biliary atresia," "laparoscopic portoenterostomy," "Kasai portoenterostomy," "open portoenterostomy," "surgery," and "treatment."Results: Nine studies, including 434 patients, were analyzed. The operative time of LPE was significantly longer than that of OPE (MD = 40.55 min, 95% CI 4.83-76.27 min, P = 0.03). There was no significant difference between the two groups in terms of the time of hospital stay, the volume of intraoperative blood loss, or the rates of cholangitis, early clearance of jaundice or two-year survival with the native liver. The subgroup analyses revealed that the rate of early clearance of jaundice in the LPE group was significantly higher than that in the OPE group in studies published after 2016 (95% CI 1.04-1.75; P = 0.02).Conclusions: The present meta-analysis provides evidence that LPE is a feasible option for patients with BA. LPE should be revaluated by further studies and longer follow-up. [ABSTRACT FROM AUTHOR]

Background: The management of contralateral patent processus vaginalis (CPPV) in children with unilateral inguinal hernia is still controversial. The objective of this study was to verify the relationship between metachronous contralateral inguinal hernia (MCIH) and CPPV, and the risk factors of MCIH.Methods: Children with unilateral inguinal hernia from three medical centers underwent either open or laparoscopic repairs. Clinical information, including demographics, morphological characteristics of CPPV, follow-up outcomes were collected.Results: Among 2942 patients (92.2%) who received open repair with successful follow-up, 185 (6.29%) developed MCIHs [125 (10.9%) on the right side and 60 (3.3%)] on the left including 156 (7.07%) younger than 3 years old and 29 (3.94%) older than 3 years old. Patients younger than 3 years old with primary left inguinal hernias more easily develop MCIHs and the difference is statistically significant. Among 5370 patients (96.0%) who received laparoscopic repair with successful follow-up, the morphology of ipsilateral patent processus vaginalis were cavernous type in 5318 (99%) and 52 (1%) were fissure type. CPPVs were identified in 2233 (41.5%) cases [1256 (35.01%) on the left side and 977 (54.80%) on the right side, P < 0.001]; 1503 cases were cavernous type (1276 cases younger than 3 years old and 227 cases older than 3 years old) and 730 cases were fissure type (422 cases younger than 3 years old and 308 cases older than 3 years old). The probability of occurence of cavernous type and CPPV in children younger than 3 years old was higher than that in children older than 3 years old.Conclusions: Not all CPPVS progress into an MIH, and approximate one of 15 CPPVs would progress into MIH. If patient with initial left-sided inguinal hernia is younger than 3 years old, when the morphology of CPPV is cavernous type identified by laparoscopic exploration, the contralateral repair would be recommended. [ABSTRACT FROM AUTHOR]