Comparison of short-term outcomes of open, laparoscopic, and robotic surgery for Kasai portoenterostomy in biliary atresia: a 10-year single center study

Objective This study aimed to clarify the comparative clinical efficacy and safety of open (OKPE), laparoscopic (LKPE), and robotic-assisted (RAKPE) approaches for Kasai portoenterostomy in patients with biliary atresia (BA). Methods We retrospectively analyzed 50 patients diagnosed with type III BA who underwent Kasai portoenterostomy between January 2015 and December 2024. Based on the surgical approach, patients were categorized into three groups: OKPE ( n = 21), LKPE ( n = 18), and RAKPE ( n = 11). Clinical characteristics, perioperative indicators, and short-term outcomes, including jaundice clearance (JC) at 6 months and one-year survival with native liver (SNL), were compared among the groups. Results RAKPE was associated with a significantly longer operative time compared to LKPE and OKPE (310 ± 39 vs. 230 ± 34 vs. 200 ± 74 min; P < 0.001). OKPE showed shorter fibrous cone dissection time (47 ± 11 vs. 66 ± 7 vs. 66 ± 9 min; P < 0.001) and less dissection blood loss [2(2–3) vs. 4(3–5) vs. 3(2–4) mL; P < 0.001]. Conversely, minimally invasive approaches achieved faster oral feeding [10 (8–10) vs. 4.5 (4–5) vs. 4 (4–5) days; p < 0.001] and shorter hospital stay [29 (23–36) vs. 19 (15–27) vs. 18 (17–28) days; P = 0.003]. No significant differences were observed across the three groups regarding 6-month JC rates (67% vs. 61% vs. 55%; P = 0.81), postoperative cholangitis incidence (55% vs. 44% vs. 38%; P = 0.66), or one-year SNL rates (71% vs. 72% vs. 64%; P = 0.85). Conclusions OKPE, LKPE, and RAKPE demonstrate comparable short-term efficacy and safety for type III BA. While OKPE offers technical advantages in hilar dissection, minimally invasive approaches significantly optimize postoperative recovery. Surgical technique selection should be individualized based on patient characteristics, surgeon experience, and institutional resources.