Long‐term outcomes after revision of Kasai portoenterostomy for biliary atresia

Shirota, Chiyoe; Uchida, Hiroo; Ono, Yoshio; Murase, Naruhiko; Tainaka, Takahisa; Yokota, Kazuki; Oshima, Koichiro; Shirotsuki, Ryo; Hinoki, Akinari; Ando, Hisami

doi:10.1002/jhbp.395

Cited by 15 publications

(9 citation statements)

References 16 publications

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“…We demonstrated fairly good long‐term NLSRs of 49% and 45% at 10 and 20 years post‐revision, respectively, comparable to those described in two other reports . On the other hand, Nakamura et al reported poorer outcomes of a 25% NLSR at 10 years and 16% at 20 years .…”

Section: Discussionsupporting

confidence: 88%

“…Some limitations to the present study need to be considered. First, even though this represents one of the largest single‐institution analyses of reoperative portoenterostomy in BA patients published to date , the number of patients who underwent revision was still fairly small. Second, the appropriate timing of revision remains a contentious issue.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the judgement of revision based on the rate of change in TB over 4 weeks post-portoenterostomy is more accurate than that over 3 weeks post-portoenterostomy (Table 3). Meanwhile, a previous report referred to the importance of revision even for patients suffering persistent jaundice by demonstrating that four of 16 such patients undergoing revision achieved long-term NLS without jaundice [7]. The present study also found that in 38% of successful revision cases, the patients showed clearance of jaundice prior to revision, as compared to 6% of failed revision cases (no significant difference; Table 3), suggesting that jaundice clearance prior to revision is preferable, but not an absolute prerequisite.…”

Section: Discussionmentioning

confidence: 99%

“…These discrepancies could be due to underlying differences across institutions and surgical services. In the former studies with preferable results, a limited number of highly experienced surgeons followed clearly determined perioperative policies with regard to revision surgeries, resulting in excellent survival outcomes . Conversely, in the latter study, some surgeons across the multiple centers involved might have performed revision surgeries without the benefit of a universal procedural policy, leading to a greater disparity of outcomes .…”

Section: Discussionmentioning

confidence: 99%

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Significance and indications for reoperative portoenterostomy in biliary atresia in light of long‐term outcome

Saito

Terui

Mitsunaga

et al. 2018

J Hepato Biliary Pancreat

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Significance and indications for reoperative portoenterostomy in biliary atresia in light of long‐term outcome

Saito

Terui

Mitsunaga

et al. 2018

J Hepato Biliary Pancreat

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“…Experiences with revision for BA patients with recurrent jaundice after initial OKPE or ILKPE have rarely been reported. In two studies, CJ rates of 60% [11] and 83.3% [12] were obtained after revision of OKPE for patients with initially successful OKPE. Naruhiko et al showed good results of RLKPE for patients with recurrent jaundice after initial OKPE.…”

Section: Discussionmentioning

confidence: 99%

Medium-term outcomes after laparoscopic revision of laparoscopic Kasai portoenterostomy in patients with biliary atresia

Zhang

Chen

et al. 2020

Preprint

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Objective To determine whether revision laparoscopic Kasai portoenterostomy (RLKPE) is a viable treatment option for patients with biliary atresia (BA) who underwent initially successful laparoscopic Kasai portoenterostomy (ILKPE). Methods The medical records of 312 patients with nonsyndromic BA who underwent ILKPE between May 2009 and May 2017 were retrospectively reviewed. The patients were divided into three groups according to their outcomes after ILKPE: group A: 25 patients who underwent RLKPE; group B: 203 patients who underwent ILKPE and required no further surgical intervention; and group C: 84 patients with failed ILKPE who either died or required liver transplantation for survival. The 3-year and 5-year survival with native liver (SNL) rates were compared between groups A and B and between groups A and C. Among the 25 patients in group A, the perioperative data of RLKPE were compared with those of ILKPE. Results Of the 312 patients who underwent ILKPE, 228 reached the normal bilirubin concentration range within 6 months postoperatively. Among them, 25 patients with a sudden cessation of bile flow underwent RLKPE. Adequate biliary drainage evidenced by normalized conjugated bilirubin levels was achieved in 80% of the patients who underwent RLKPE. The perioperative variables, including operative time, blood loss, rate of conversion to open surgery and complications of RLKPE, were not significantly different between RLKPE and ILKPE. The 3-year and 5-year SNL rates in patients after RLKPE were 64.0% and 52.0%, respectively, which were not significantly different from the corresponding 86.2% and 73.9% in patients after unrevised ILKPE (P > 0.05) but were significantly better than the corresponding values of group C (P < 0.01). Conclusion Our data demonstrated that with appropriate patient selection, RPLKE can be a viable and effective treatment opinion in patients who experience sudden cessation of bile drainage after ILKPE. RPLKE can delay the need for liver transplantation, yielding encouraging medium-term patient outcomes.

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Multicenter, retrospective, comparative study of laparoscopic and open Kasai portoenterostomy in children with biliary atresia from Japanese high‐volume centers

Murase

Hinoki

Shirota

et al. 2019

J Hepato Biliary Pancreat

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BackgroundMulticenter study was undertaken to analyze the results of laparoscopic and open Kasai portoenterostomy.MethodsSubjects were infants with type III biliary atresia who underwent open operation (n = 106) or laparoscopic operation (n = 21) between January 2012 and December 2015. Clinical data were compared between open and laparoscopic operations (2016‐0534). Propensity score matching was performed to reduce the effect of treatment selection bias. Multivariate analyses were used to estimate the effect of the surgical approach on the jaundice clearance rate and the native liver survival rate.ResultsThe postoperative jaundice clearance rate and the 1‐year native liver survival rate were not significantly different between open and laparoscopic operations. Rates of cholangitis and major complications of laparoscopic operation were comparable to those of open operation. Blood loss, time to resume oral intake, time to drain removal, and duration of analgesic usage of laparoscopic operation were significantly superior to those of open operation. Similar results were observed when analysis was adjusted based on propensity score. Multivariate analyses demonstrated that only age at operation was a poor prognostic factor.ConclusionLaparoscopic Kasai portoenterostomy was associated with several favorable perioperative outcomes compared with open Kasai portoenterostomy. The difference of surgical approach was not a significant independent predictor.

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Long‐term outcomes after revision of Kasai portoenterostomy for biliary atresia

Abstract: Revision of PE was suitable for repeated cholangitis. Revision for recurrent jaundice, regardless of whether the initial PE was successful, could have a limited but positive effect in preventing long-term progressive liver failure.

Cited by 15 publications

References 16 publications

Significance and indications for reoperative portoenterostomy in biliary atresia in light of long‐term outcome

Significance and indications for reoperative portoenterostomy in biliary atresia in light of long‐term outcome

Medium-term outcomes after laparoscopic revision of laparoscopic Kasai portoenterostomy in patients with biliary atresia

Multicenter, retrospective, comparative study of laparoscopic and open Kasai portoenterostomy in children with biliary atresia from Japanese high‐volume centers

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