Partial quadrate lobectomy improves early outcomes of laparoscopic Kasai surgery in type III biliary atresia.

Objective: To evaluate the early efficacy and safety of partial quadrate lobectomy during laparoscopic Kasai surgery for type III biliary atresia.

Methods: This retrospective study included 25 children diagnosed with type III biliary atresia, who underwent laparoscopic Kasai surgery between February 2018 and July 2022. Patients were divided into two groups: one with partial quadrate lobectomy and the other without. Data collected included age, gender, weight, incidence of cholangitis before and after surgery, one-year native liver survival, intraoperative blood loss, surgery duration, and jaundice clearance at 6 and 12 months. Follow-up results were compared between the groups.

Results: The partial quadrate lobectomy group (14 patients) had a mean weight of 5.50 kg and average age of 66.79 days, while the control group (11 patients) had a similar weight (5.50 kg) and a mean age of 71.09 days. Weight comparison showed no significant difference (5.50 kg vs. 5.50 kg, P = 0.427). One-year postoperative native liver survival was 9/14 in the partial quadrate lobectomy group vs. 6/11 in the control group (P = 0.654).Intraoperative blood loss was similar between groups (P > 0.05), but the shorter operative time (301 vs. 347 min) associated with partial quadrate lobe resection may reduce anesthesia-related risks in infants, particularly given their limited physiological reserve. The reduced cholangitis rate (29% vs. 73%) aligns with prior reports suggesting that improved hilar exposure facilitates more precise dissection of fibrotic remnants, potentially minimizing postoperative bile stasis and infection. Jaundice clearance (defined as TBIL <20 μmol/L) was achieved in 8/14 (57.1%) of the partial quadrate lobectomy group vs. 3/11 (27.3%) in the control group at 6 months (P = 0.025), and 10/14 (71.4%) vs. 4/11 (36.4%) at 12 months (P = 0.031). The lower TBIL levels (5.11 vs. 9.67 mg/dl) at 6 months suggest enhanced bile drainage efficacy, which is critical for delaying or avoiding liver transplantation in this population.

Conclusion: Partial quadrate lobectomy during laparoscopic Kasai surgery reduces operation time, lowers cholangitis incidence, and improves jaundice clearance rates without increasing intraoperative blood loss or adversely affecting one-year native liver survival. It is a safe and feasible adjunct to improve early postoperative outcomes.