Does pneumoperitoneum adversely affect growth, development and liver function in biliary atresia patients after laparoscopic portoenterostomy?

Pediatr Surg Int. 2015 Jan;31(1):45-51. doi: 10.1007/s00383-014-3625-4. Epub 2014 Oct 18.


Purpose: We assessed the effect of high partial pressure of arterial carbon dioxide (PaCO2) due to pneumoperitoneum (PP) on growth (height/weight) and development (gross/fine motor function, receptive/expressive communication, and social interaction), by comparing outcome after portoenterostomy (PE) for biliary atresia (BA) using laparoscopic PE (LPE: n = 13) and open PE (OPE: n = 13) cases performed between 2005 and 2014.

Methods: Our PE is based on Kasai's original PE. All data were collated prospectively.

Results: Differences in duration of follow-up (LPE: 38.8 months; OPE: 38.1 months), jaundice clearance (LPE: 12/13 = 92.3 %; OPE: 9/13 = 69.2 %), survival with the native liver (LPE: 10/13 = 76.9 %; OPE: 9/13 = 69.2 %), incidence of cholangitis, hypersplenism, and incidence of esophageal varices were not significant. Mean intraoperative PaCO2 was significantly higher in LPE (LPE: 50.1 mmHg; OPE: 40.7 mmHg, p < 0.05). Liver function impairment was not statistically different, although LPE results were slightly worse. There was no overall delay in growth observed, although height/weight gain was more consistent in LPE. The pattern of developmental delay observed was similar for LPE and OPE suggesting that developmental delay is not PE-related; in other words, PP is not implicated in developmental delay.

Conclusions: PP during LPE would appear to have no adverse effects on overall growth/development and liver function in BA patients.

MeSH terms

  • Biliary Atresia / surgery*
  • Child Development*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Laparoscopy*
  • Liver Function Tests
  • Male
  • Pneumoperitoneum*
  • Portoenterostomy, Hepatic / methods*
  • Prospective Studies