Comparative Analysis of Medium-Term Outcomes Between Robotic-Assisted and Open Kasai Portoenterostomy for Biliary Atresia.

OBJECTIVE: To compare the mid-term outcomes of robot-assisted Kasai portoenterostomy (RAKPE) and open Kasai portoenterostomy (OKPE) in children with biliary atresia. METHODS: In this retrospective dual-center cohort study, 70 children with biliary atresia underwent Kasai portoenterostomy between January 2022 and February 2024, including 38 who underwent RAKPE and 32 who underwent OKPE. Overall postoperative complications, jaundice clearance rate (JCR), cumulative incidence of cholangitis, liver stiffness, and native liver survival (NLS) were compared. Follow-up continued through February 2026. RESULTS: The overall complication rate was lower in the RAKPE group than in the OKPE group (10.5% vs. 31.2%, P = 0.038). JCR was higher after RAKPE, although the difference was not statistically significant (73.7% vs. 53.1%, P = 0.074). The cumulative incidence of cholangitis was comparable between groups at 6 months (17.9% vs. 18.3%, P = 0.920), but was lower in the RAKPE group at 1 year (22.6% vs. 33.7%, P = 0.031) and 2 years (31.2% vs. 43.3%, P = 0.022); however, the overall between-group difference was not statistically significant by Gray's test (P = 0.174). Liver stiffness did not differ significantly between groups. NLS was better in the RAKPE group (log-rank χ2 = 5.44, P = 0.020); the 1- and 2-year NLS rates were 78.9% and 68.4% versus 75.0% and 53.1%, respectively. CONCLUSIONS: Compared with OKPE, RAKPE was associated with fewer postoperative complications, a lower mid-term cumulative incidence of cholangitis, and improved native liver survival in children with biliary atresia.