Outcome of biliary atresia after Kasai’s portoenterostomy: A 15-year experience

Redkar, Rajeev; Karkera, Parag; Raj, Vinod; Bangar, Anant; Hathiramani, Varun; Krishnan, Janani

doi:10.1007/s13312-017-1091-5

Cited by 26 publications

(22 citation statements)

References 13 publications

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“…The incidence of ascites in BA patients during the 1st year after HPE is reported to reach a maximum of 20%. 18,39 In our series, we found 5% of early ascites.…”

Section: Ascitessupporting

confidence: 48%

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Perioperative Complications after Kasai Hepatoportoenterostomy: Data from the Swiss National Biliary Atresia Registry

Calinescu¹,

Wilde²,

Korff

et al. 2019

Eur J Pediatr Surg

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Introduction Hepatoportoenterostomy (HPE) is the first-line treatment for biliary atresia (BA) patients. This study aims to describe perioperative complications after HPE and to analyze their impact on outcome. Materials and Methods Patients with HPE (Swiss National Biliary Atresia Registry, 1994–2017) were retrospectively analyzed. Perioperative complications were defined as complications occurring up to 30 days after surgery. Surgical complications were defined as directly related to the surgical act; medical complications were defined as any other deviation from the uneventful postoperative course. Results Sixty-two patients were included. Median age at HPE was 63 days (18–126). Twenty six patients out of 62 (42%) had ≥ 1 complications: 6/62 (10%) surgical, 24/62 (39%) medical, that is, we observed 7 surgical and 28 medical complications. As for medical complications, cholangitis was the most frequent: 19/28 (68%). Lower gestational age at birth correlated with more overall complications (p = 0.02). Age, weight at HPE, syndromic BA, and postoperative steroid administration were not significantly correlated. There were no perioperative deaths. Perioperative complications did not correlate with overall survival (p = 0.14) and survival with native liver (p = 0.55). Conclusion HPE is often associated with perioperative medical complications. Lower gestational age at birth was significantly associated with more complications. Perioperative complications had no impact on overall outcome.

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“…The incidence of ascites in BA patients during the 1st year after HPE is reported to reach a maximum of 20%. 18,39 In our series, we found 5% of early ascites.…”

Section: Ascitessupporting

confidence: 48%

“…In the literature, one case of ventilator associated pneumonia led to death more than 3 months after HPE, but might rather be related to the disease progression than to the postoperative state. 39…”

Section: Ascitesmentioning

confidence: 99%

Perioperative Complications after Kasai Hepatoportoenterostomy: Data from the Swiss National Biliary Atresia Registry

Calinescu¹,

Wilde²,

Korff

et al. 2019

Eur J Pediatr Surg

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“…Although perioperative complications were common in BA patients, they were not predictors for 2-years NLS, which suggested perioperative complications had no impact on the BA prognosis. However, JC was considered a crucial predictor for improved NLS ( 11 , 29 – 32 ). In a large study in Japan, it was demonstrated that TBIL <17.1 μmol/L at 3 months post-KPE predicted an improved NLS ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Perioperative Complications in the Management of Biliary Atresia

Wang

Tang

et al. 2020

Front. Pediatr.

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Purpose: To analyze the influence of perioperative complications in the management of biliary atresia (BA). Methods: A retrospective study was performed using a total of 422 BA patients who underwent Kasai portoenterostomy (KPE) in a single institution between February 2016 and May 2017. Data on patients' clinical characteristics, laboratory examinations, perioperative complications, and outcomes were collected. Unpaired two-tailed t-test and χ 2 test were employed for the comparison between BA patients with and without perioperative complications. Cox regression analysis was used to screen the risk factors for 2-years NLS in BA, and their influence on the 2-years NLS was analyzed using Kaplan-Meier survival analysis as well as the log-rank test. Results: The incidence of perioperative complications, 6-months jaundice clearance (JC) and 2-years native liver survival (NLS) rate were 60.4, 59.5, and 56.6%, respectively. Patients with perioperative complications had lower serum albumin (ALB) level, but higher aspartate aminotransferase-to-platelet ratio index (APRI) and international normalized ratio (INR) levels when compared with those without perioperative complications (ALB, P < 0.05; APRI, P < 0.01; INR, P < 0.05). Moreover, perioperative complications were correlated with glucocorticoid administration (P = 0.002). Univariate Cox regression analysis showed no relationship between perioperative complications and 2-years NLS (P > 0.05). However, multivariate Cox regression analysis indicated 6-months JC was an independent protective factor for 2-years NLS [P < 0.0001, hazard ratio (HR) = 0.074, 95% confidence interval = 0.05-0.11], and concordance index of this prediction model including age, weight, APRI, glucocorticoid, and 6-months JC was 0.811. Conclusion: Although perioperative complication is common during and after KPE, it had no influence on the prognosis of BA. However, assessment of the serum level of total bilirubin after KPE may serve as an important predictor for the outcome in BA.

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“…The adequate level of transection of the fibrous portal plate is one of the most important steps in the Kasai procedure, which is also the most difficult part of the operation. The native liver survival (NLS) rate is clearly different in different centers [4~7] .At present, most studies showed that early clearance of jaundice after Kasai procedure is an important factor for good prognosis [4,5] . The adequate level of transection of the fibrous portal plate plays a key role in the early clearance of jaundice [1] .…”

Section: Discussionmentioning

confidence: 99%

Liver stiffness measurement predicts the difficulty of Kasai procedure in Biliary Atresia: a single center retrospective analysis of 199 patients

Shen

Chen

Peng

et al. 2019

Preprint

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Background: Kasai procedure is the standard initial treatment of infants with biliary atresia. The key to perform a successful surgery is to accurately remove the fibrous portal plate near the liver hilum. Yet how to estimate surgical difficulty pre-operatively remains unclear. This study aims to design an algorithm that predicts the difficulty of Kasai procedure using liver stiffness measurement (LSM). Methods: 199 patients were included from April 2012 to December 2016. The patients were all surgically diagnosed with biliary atresia. Group A comprised of patients with porta hepatis retraction (the angle between the plane of the fibrous porta plate and the plane of the medial liver closest to the plate was equal to or smaller than 90°), group B comprised of patients without porta hepatis retraction (the angle between the plane of the fibrous porta plate and the plane of the medial liver closest to the plate was greater than 90°). Liver function measurements and LSM were measured for all patients within three days before surgery. Results: Our study included 19 cases in group A (9 males, 10 females) and 180 cases in group B (87 males, 93 females). LSM had statistical differences between the two groups, 28.10(14.90) kPa VS 10.89(7.10) kPa, P =0.000. There was a significant relationship between LSM and operative age, TBA, AST, GGT (P=0.000, 0.003, 0.003, 0.012, correlation coefficient =0.323, 0.213, 0.207, 0.179). The AUROC of LSM was 0.919. When the cutoff value was 15.15 kPa(OR=3.989; P = 0.000), the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 0.947, 0.750, 0.285, 0.992 and 0.768, respectively. When the value was 23.75kPa(OR=3.483; P = 0.000), the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 0.631, 0.950, 0.571, 0.960 and 0.919, respectively. Conclusions: LSM can be used to predict the difficulty in dissecting fibrous portal plate, and in turn, the difficulty of Kasai procedure. LSM>23.75 kPa suggests a more complicated surgery.

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Outcome of biliary atresia after Kasai’s portoenterostomy: A 15-year experience

Abstract: Jaundice clearance at 3 months post surgery is a good early indicator of long term success.

Cited by 26 publications

References 13 publications

Perioperative Complications after Kasai Hepatoportoenterostomy: Data from the Swiss National Biliary Atresia Registry

Perioperative Complications after Kasai Hepatoportoenterostomy: Data from the Swiss National Biliary Atresia Registry

Evaluation of Perioperative Complications in the Management of Biliary Atresia

Liver stiffness measurement predicts the difficulty of Kasai procedure in Biliary Atresia: a single center retrospective analysis of 199 patients

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