{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:15:30Z","timestamp":1787008530718,"version":"build-2736575974"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Liver mobilization (LM) during Kasai portoenterostomy (KPE) is used by some surgeons to improve exposure but remains controversial due to anaesthetic challenges and concerns about increased adhesions complicating liver transplantation (LT). This study evaluated the impact of LM on intraoperative, postoperative, and long-term outcomes in biliary atresia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multicentre case-control study involving high-volume biliary atresia centres in Europe and North America was conducted. Preoperative, intraoperative, and postoperative clinical and laboratory data were retrospectively collected and comparisons were made between groups with and without LM. Long-term native liver survival was assessed by Kaplan\u2013Meier analysis with log-rank testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In all, 204 patients were included in the study: 142 in the LM group and 62 in the No LM group. During KPE, the LM group received catecholamines more frequently (100 (100%) versus 13 (46%) patients; P &amp;lt; 0.001), required more intravenous fluids (116.2 versus 79.15\u2005ml\/kg; P &amp;lt; 0.014), and had higher transfusion rates (18.91 versus 7.59\u2005ml\/kg; P &amp;lt; 0.001) than the No LM group. After KPE, transaminases were elevated in both groups, but significantly higher in the LM group (aspartate aminotransferase, 1166 versus 374.6\u2005U\/l; P &amp;lt; 0.001; alanine aminotransferase 456.8 versus 206.7\u2005U\/l; P &amp;lt; 0.001). These values normalized within 7 days after KPE. During subsequent LT, patients who had undergone LM experienced significantly shorter operative times (295.3 versus 509.8\u2005minutes; P &amp;lt; 0.001) and required lower blood transfusion volumes (55.26 versus 95.81\u2005ml\/kg; P &amp;lt; 0.001). Of note, patients who underwent LM showed significantly prolonged native liver survival (P &amp;lt; 0.024).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LM during KPE leads to increased intraoperative haemodynamic compromise requiring more intensive anaesthetic management and causes transient postoperative hepatic stress. LM does not appear to negatively affect LT and is associated with improved long-term native liver survival. These findings suggest potential benefits of LM during KPE, warranting further investigation in prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag064","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T11:46:01Z","timestamp":1777031161000},"source":"Crossref","is-referenced-by-count":1,"title":["Liver mobilization during Kasai portoenterostomy: retrospective multicentre analysis"],"prefix":"10.1093","volume":"10","author":[{"given":"Marie","family":"Uecker","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Hannover Medical School , Hannover ,","place":["Germany"]},{"name":"Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Holweg","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Urology, University Children\u2019s Hospital T\u00fcbingen , T\u00fcbingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Hukkinen","sequence":"additional","affiliation":[{"name":"Section of Pediatric Surgery, New Children\u2019s Hospital, University of Helsinki , Helsinki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Moratilla-Lape\u00f1a","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, La Paz Children\u2019s University Hospital , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine","family":"Dr\u00e4ger","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Domasch","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Hannover Medical School , Hannover ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Nickel","sequence":"additional","affiliation":[{"name":"Clinic of Anesthesiology and Intensive Care Medicine, Hannover Medical School , Hannover ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3989-8650","authenticated-orcid":false,"given":"S\u00f6ren","family":"Wiesner","sequence":"additional","affiliation":[{"name":"Institute of Biostatistics, Hannover Medical School , Hannover ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3347-2675","authenticated-orcid":false,"given":"Cornelius Jakob","family":"van Beekum","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, & Transplant Surgery, Transplant Center Hannover, Hannover Medical School , Hannover ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Urology, University Children\u2019s Hospital T\u00fcbingen , T\u00fcbingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uta","family":"Herden","sequence":"additional","affiliation":[{"name":"Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, La Paz Children\u2019s University Hospital , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikko","family":"Pakarinen","sequence":"additional","affiliation":[{"name":"Section of Pediatric Surgery, New Children\u2019s Hospital, University of Helsinki , Helsinki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Superina","sequence":"additional","affiliation":[{"name":"Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago , Chicago, Illinois ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim F","family":"Kuebler","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Urology, Hospital Bremen-Mitte , Bremen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5576-5906","authenticated-orcid":false,"given":"Christoph","family":"Slavetinsky","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Urology, University Children\u2019s Hospital T\u00fcbingen , T\u00fcbingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omid","family":"Madadi-Sanjani","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]},{"name":"Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"2026060814474907900_zrag064-B1","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1055\/s-0041-1723994","article-title":"Centralization of biliary atresia: has Germany learned its lessons?","volume":"32","author":"Madadi-Sanjani","year":"2021","journal-title":"Eur J Pediatr Surg"},{"key":"2026060814474907900_zrag064-B2","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1097\/SLA.0000000000006273","article-title":"The outcome of a centralization program in biliary atresia: twenty years and beyond","volume":"281","author":"Davenport","year":"2025","journal-title":"Ann Surg"},{"key":"2026060814474907900_zrag064-B3","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jamcollsurg.2017.09.009","article-title":"Treatment policy and liver histopathology predict biliary atresia outcomes: results after national centralization and protocol biopsies","volume":"226","author":"Hukkinen","year":"2018","journal-title":"J Am Coll Surg"},{"key":"2026060814474907900_zrag064-B4","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/1750-1172-8-128","article-title":"Aetiology of biliary atresia: what is actually known?","volume":"8","author":"Petersen","year":"2013","journal-title":"Orphanet J Rare Dis"},{"key":"2026060814474907900_zrag064-B5","doi-asserted-by":"crossref","first-page":"6601","DOI":"10.3390\/jcm11216601","article-title":"Surgical and medical aspects of the initial treatment of biliary atresia: position paper","volume":"11","author":"Davenport","year":"2022","journal-title":"J Clin Med"},{"key":"2026060814474907900_zrag064-B6","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1055\/s-2007-965147","article-title":"Surgery for biliary atresia\u2014is there a European consensus?","volume":"17","author":"Davenport","year":"2007","journal-title":"Eur J Pediatr Surg"},{"key":"2026060814474907900_zrag064-B7","first-page":"101519","article-title":"Norepinephrine infusion for preventing hypotension during hepatic exteriorization in Kasai portoenterostomy in infants with biliary atresia: a randomized controlled trial","volume":"44","author":"Sarhan","year":"2025","journal-title":"Anaesth Crit Care Pain Med"},{"key":"2026060814474907900_zrag064-B8","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1111\/j.1460-9592.2000.00579.x","article-title":"Anaesthesia, perioperative management and outcome of correction of extrahepatic biliary atresia in the infant: a review of 50 cases in the King\u2019s College Hospital series","volume":"10","author":"Green","year":"2000","journal-title":"Paediatr Anaesth"},{"key":"2026060814474907900_zrag064-B9","first-page":"820","article-title":"Extended adhesion-sparing liver eversion during Kasai portoenterostomy for infants with biliary atresia","volume":"8","author":"Parolini","year":"2021","journal-title":"Child Basel Switz"},{"key":"2026060814474907900_zrag064-B10","doi-asserted-by":"crossref","first-page":"17235","DOI":"10.3748\/wjg.v20.i45.17235","article-title":"Anterior vs conventional approach hepatectomy for large liver cancer: a meta-analysis","volume":"20","author":"Li","year":"2014","journal-title":"World J Gastroenterol"},{"key":"2026060814474907900_zrag064-B11","doi-asserted-by":"crossref","first-page":"108535","DOI":"10.1016\/j.ejso.2024.108535","article-title":"Anterior approach with or without liver hanging maneuver versus conventional approach in major liver resections. A systematic review and meta-analysis of randomized controlled trials","volume":"50","author":"Granieri","year":"2024","journal-title":"Eur J Surg Oncol"},{"key":"2026060814474907900_zrag064-B12","doi-asserted-by":"crossref","first-page":"1549636","DOI":"10.3389\/fped.2025.1549636","article-title":"Perioperative comparison of whether the liver was lifted out of the abdominal cavity in Kasai surgery","volume":"13","author":"Xu","year":"2025","journal-title":"Front Pediatr"},{"key":"2026060814474907900_zrag064-B13","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.jpedsurg.2018.06.028","article-title":"Surgical modifications of the Kasai hepatoportoenterostomy minimize invasiveness without compromising short- and medium-term outcomes","volume":"54","author":"Park","year":"2019","journal-title":"J Pediatr Surg"},{"key":"2026060814474907900_zrag064-B14","author":"European Reference Networks"},{"key":"2026060814474907900_zrag064-B15","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1093\/bjs\/znad034","article-title":"Implementation and validation of a novel instrument for the grading of unexpected events in paediatric surgery: Clavien\u2013Madadi classification","volume":"110","author":"Madadi-Sanjani","year":"2023","journal-title":"Br J Surg"},{"key":"2026060814474907900_zrag064-B16","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1002\/jpr3.12071","article-title":"Retrospective analysis of the standardized BARD criteria for acute cholangitis in biliary atresia patients","volume":"5","author":"Madadi-Sanjani","year":"2024","journal-title":"JPGN Rep"},{"key":"2026060814474907900_zrag064-B17","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1007\/s00104-009-1708-x","article-title":"Predictive parameters in children with biliary atresia","volume":"80","author":"Leonhardt","year":"2009","journal-title":"Chirug"},{"key":"2026060814474907900_zrag064-B18","doi-asserted-by":"crossref","first-page":"2693","DOI":"10.1007\/s00431-023-04925-1","article-title":"Age at surgery and native liver survival in biliary atresia: a systematic review and meta-analysis","volume":"182","author":"Hoshino","year":"2023","journal-title":"Eur J Pediatr"},{"key":"2026060814474907900_zrag064-B19","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1213\/00000539-200002000-00046","article-title":"Interference of cerebral near-infrared oximetry in patients with icterus","volume":"90","author":"Madsen","year":"2000","journal-title":"Anesth Analg"},{"key":"2026060814474907900_zrag064-B20","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1089\/jir.2023.0015","article-title":"Remote ischemic conditioning relieves necrotizing enterocolitis through regulation of redox and inflammation","volume":"43","author":"Zhang","year":"2023","journal-title":"J Interferon Cytokine Res"},{"key":"2026060814474907900_zrag064-B21","first-page":"e70041","article-title":"Effects of remote ischemic conditioning on postoperative recovery after hepatectomy: a randomised controlled trial","volume":"45","author":"Tian","year":"2025","journal-title":"Liver"},{"key":"2026060814474907900_zrag064-B22","doi-asserted-by":"crossref","first-page":"2559","DOI":"10.1016\/j.jpedsurg.2019.08.026","article-title":"Risk factors and prognostic effects of cholangitis after Kasai procedure in biliary atresia patients: a retrospective clinical study","volume":"54","author":"Liu","year":"2019","journal-title":"J Pediatr Surg"},{"key":"2026060814474907900_zrag064-B23","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1007\/s00383-017-4174-4","article-title":"Biliary atresia and liver transplantation: results and thoughts for primary liver transplantation in select patients","volume":"33","author":"Superina","year":"2017","journal-title":"Pediatr Surg Int"},{"key":"2026060814474907900_zrag064-B24","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/MPG.0000000000000986","article-title":"Liver transplantation for biliary atresia: is there a difference in outcome for infants?","volume":"62","author":"Arnon","year":"2016","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"2026060814474907900_zrag064-B25","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1111\/tri.13872","article-title":"Short- and long-term results of liver transplantation according to age at transplant: a single center experience of 351 children","volume":"34","author":"\u00d6zen","year":"2021","journal-title":"Transpl Int"},{"key":"2026060814474907900_zrag064-B26","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1002\/lt.24132","article-title":"Impact of Kasai portoenterostomy on liver transplantation outcomes: a retrospective cohort study of 347 children with biliary atresia","volume":"21","author":"Neto","year":"2015","journal-title":"Liver Transpl"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/3\/zrag064\/68490960\/zrag064.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/3\/zrag064\/68490960\/zrag064.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T18:47:54Z","timestamp":1780944474000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zrag064\/8704039"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":26,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,5,12]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zrag064","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,5,12]]},"article-number":"zrag064"}}