Middle hepatic artery transection in laparoscopic Kasai portoenterostomy for Type III biliary atresia: a prospective cohort study.

OBJECTIVE: To evaluate the clinical significance of middle hepatic artery (MHA) transection during laparoscopic Kasai portoenterostomy (KPE) in children with type III biliary atresia (BA). METHODS: This prospective cohort study enrolled 116 consecutive children with type III BA who underwent laparoscopic KPE at Huai'an Maternal and Child Health Care Hospital between January 2014 and May 2024. Among them, 92 (79.3%) patients with an intraoperatively visible MHA were included in the final analysis, and divided into two groups: the MHA transection group (n=54) and the MHA preservation group (n=38). Perioperative parameters and long-term follow-up outcomes were prospectively collected and compared between the two groups. RESULTS: No statistically significant differences were noted between the two groups in terms of sex distribution, age at surgery, or body weight (all P>0.05). The operation time was significantly shorter in the MHA transection group than in the MHA preservation group [(195.5±15.0) min vs. (228.7±20.5) min, P<0.001]. There were no significant differences in intraoperative blood loss, postoperative oral feeding time, and hospital stay between the two groups (all P > 0.05). In terms of hepatic function parameters, no significant between-group differences were observed in preoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), and direct bilirubin (DBIL) (all P > 0.05). Similarly, no significant between‑group differences were observed in ALT, AST, TBIL, or DBIL at 1‑, 2‑, and 6‑month postoperatively (all P > 0.05). Six months after surgery, cholangitis developed in 10 cases of the MHA transection group and 6 cases of the MHA preservation group (p=0.734). The 6-month jaundice clearance rate was 70.3% in the MHA transection group and 73.6% in the MHA preservation group (P=0.728), and the 2-year native liver survival rate was 66.6 and 68.4%, respectively (P=0.860), with no statistically significant differences. CONCLUSION: The results from our cohort demonstrated that MHA transection was relatively safe in the short term, with no instances of hepatic segment IV ischemia or necrosis detected. As it facilitated hilar dissection, this maneuver was associated with shorter operative time, lending support to the clinical applicability of MHA transection.