Enhanced Outcomes in Newborn Biliary Atresia via Laparoscopic Surgery

Nagoya University reports that laparoscopic biliary atresia surgery reduces intraoperative blood loss and improves early jaundice recovery versus open Kasai–type procedures in newborns—shifting the immediate perioperative risk profile for neonatal hepatic surgery.

The team performed a multicenter, propensity score–matched retrospective analysis of 356 infants who underwent corrective surgery at a median age of about two months and were followed for a mean of 13 years. Reported primary endpoints were intraoperative blood loss and jaundice clearance, with laparoscopy compared directly to open surgery.

The report states a 68% reduction in intraoperative blood loss with laparoscopy and higher jaundice clearance after laparoscopy (81%) versus open surgery (64%).

Higher-dose postoperative steroids did not show a clear outcome benefit in this cohort; children reported to receive >90 mg/kg post-surgery were more likely to require liver transplantation. Practical postoperative differences after laparoscopic versus open Kasai-type procedures included smaller wound‑care needs, lower early analgesic requirements, and earlier initiation of enteral feeds, while total hospital stay and long-term native-liver survival remained similar. Laparoscopy added roughly an hour of operative time—factors that affect recovery trajectories and downstream resource use in neonatal units.

Looking ahead, prospective multicenter validation and carefully protocolled adoption pathways are recommended to confirm these findings and ensure safe, equitable implementation of laparoscopic approaches in neonatal biliary atresia surgery.

Key Takeaways:

• Laparoscopic Kasai–style repair showed substantially less intraoperative blood loss and higher early jaundice clearance than open repair, offering an immediate perioperative advantage.
• Neonatal surgical teams, anaesthesiologists, and families of infants with biliary atresia—perioperative risk assessment, transfusion planning, and counseling may change where laparoscopy is feasible.
• Perioperative planning should reflect laparoscopy’s operative profile when appropriate, comparative outcomes should be included in informed consent discussions, and priority research should target multisite prospective validation and longer-term transplant‑free survival metrics.