{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:17:43Z","timestamp":1781630263564,"version":"3.54.5"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Biliary atresia (BA) is a progressive fibro-obliterative disease of the extrahepatic bile ducts. Laparoscopic Kasai portoenterostomy (LKPE) has emerged as a minimally invasive alternative to the open approach. We aimed to evaluate the feasibility, perioperative outcomes, and early prognostic factors of LKPE in a single center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective single-center study. Feasibility, operative metrics (including the learning curve), incidence of cholangitis, native liver survival, and clinical outcomes were assessed using standard statistical methods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 33 patients (14 females, 19 males), the age at surgery was &amp;lt;60 days (12 patients), 60\u201389 days (13 patients), and &amp;gt;90 days (8 patients). The median operative time was 240\u2005min, showing a declining trend with increasing experience. One conversion (1\/33) to open surgery was required due to inadequate hilar visualization. Postoperative cholangitis occurred in 51.5% of cases and was associated with an increased risk of native liver failure (HR\u2009=\u20093.6, <jats:italic>p<\/jats:italic>\u2009=\u20090.051). The native liver survival rate at study completion was 54.5%, with 5 patients (15.2%) requiring liver transplantation. The overall mortality rate was 30.3%, primarily due to sepsis and cholangitis-related complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LKPE is a feasible and effective surgical option for biliary atresia. Despite its advantages, including enhanced hilar visualization and faster recovery, the high incidence of postoperative cholangitis remains a major challenge that adversely affects native liver survival. Optimizing perioperative management, implementing prophylactic strategies against cholangitis, and expanding pediatric liver transplantation programs in resource-limited settings are essential to improving outcomes. Further prospective studies with long-term follow-up are needed to refine surgical techniques and optimize patient management.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1666539","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T04:11:46Z","timestamp":1759464706000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Laparoscopic Kasai portoenterostomy for biliary atresia: first experience from Central 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