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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]

The matrix metalloproteinase-7 (MMP-7) is a promising marker for identification of biliary atresia. We assessed the accuracy and clinical value of MMP-7 for diagnosis of biliary atresia in infants. We searched MEDLINE, Embase, ISI Web of Knowledge, and the Cochrane Library, from inception to December 30, 2020. We included articles written in English, Chinese, or French that investigated MMP-7 for differentiation of biliary atresia infants from those with other form of cholestasis. Two review authors independently assessed eligibility for inclusion, evaluated the methodological quality of included studies, and extracted data to estimate diagnostic accuracy. We calculated individual and pooled sensitivities and specificities. We used I2 to test heterogeneity and investigated the source of heterogeneity. Our search identified 4 studies (593 infants). Risk of bias in the included studies was generally low. Bivariate analysis yielded a mean sensitivity of 0.96 (95% CI: 0.93–0.98) and specificity of 0.91 (95% CI: 0.85–0.95). The area under the receiver operating characteristic curve was 0.97 (95% CI: 0.95–0.98). A moderate heterogeneity was found among the included studies as the I2 values for sensitivity and specificity were 8.6% (95% CI: 1.5–19.04) and 56.7% (95% CI: 28.91–70.07), respectively. After a sensitivity analysis, there was no change in sensitivity and MMP-7 specificity ranged from 0.91 to 0.93. The serum MMP-7 is a helpful biomarker for diagnosis of biliary atresia in cholestasis infants. Nevertheless, it cannot be recommended as the single definitive test for biliary atresia diagnosis; further primary clinical research is mandatory.Trial registration: prospero230839 [ABSTRACT FROM AUTHOR]