Postoperative intestinal obstruction in patients with biliary atresia impedes biliary excretion and results in subsequent liver transplantation

Takimoto, Aitaro; Sumida, Wataru; Amano, Hodaka; Shirota, Chiyoe; Tainaka, Takahisa; Yokota, Kazuki; Makita, Satoshi; Yasui, Akihiro; Kanou, Yoko; Hinoki, Akinari; Uchida, Hajime

doi:10.1007/s00383-020-04807-9

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…Frequent re uxes of intestinal content into the ascending jejunal limb damage the bile capillaries and worsen bile ow. Our previous report indicated that postoperative intestinal obstruction negatively affects bile secretion, and we proposed that creating an anti-re ux valve would prevent an increase in the intraluminal pressure of the hepatic hilum and maintain good bile ow [17]. Our new ndings supported this hypothesis.…”

Section: Discussionsupporting

confidence: 80%

Adding a spur valve to laparoscopic portoenterostomy for patients with biliary atresia can achieve a high jaundice clearance rate and lower the number of episodes of cholangitis

et al. 2022

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Purpose: This study aimed to evaluate the e cacy of adding a spur valve to laparoscopic portoenterostomy for patients with biliary atresia. Methods: We retrospectively reviewed the records of all patients diagnosed with biliary atresia (BA) who underwent laparoscopic portoenterostomy (Lap-PE) between 2013 and 2021. The patients were divided into two groups: Lap-PE with a spur valve (spur group) and without it (control group). Perioperative management was the same in both groups. We compared patient backgrounds and clinical outcomes, including jaundice clearance and the number of postoperative cholangitis episodes.Results: Of 63 patients reviewed, 16 received a spur valve. There were no statistically signi cant differences in the patient backgrounds between the groups. All patients in the spur group achieved jaundice clearance. The number of postoperative cholangitis episodes one year after surgery was signi cantly lower in the spur group than in the control group (1 [0-3] vs. 3 [0-9], p = 0.04). The jaundicefree survival rate with the native liver at one year after surgery was signi cantly higher in the spur group (100% vs. 53%, p= 0.01).Conclusions: Adding a spur valve during Lap-PE signi cantly lowered the number of cholangitis episodes one year after surgery.

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Section: Discussionsupporting

confidence: 80%

Adding a spur valve to laparoscopic portoenterostomy for patients with biliary atresia can achieve a high jaundice clearance rate and lower the number of episodes of cholangitis

et al. 2022

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“…Sheyn et al concluded that approximately 0.12–1.1% of patients who underwent hysterectomy developed small bowel obstruction 8 , which is the most severe subtype of POI and requires surgical intervention. Increased incidence of postoperative nausea and vomiting (PONV) by POI is associated with a longer hospital stay, worsening patient condition, increased 30-day readmission rates and higher hospital costs 9 , 10 .…”

Section: Introductionmentioning

confidence: 99%

Impact of intravenous dexmedetomidine on gastrointestinal function recovery after laparoscopic hysteromyomectomy: a randomized clinical trial

Cai

Liu

et al. 2022

Sci Rep

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Postoperative intestinal ileus is common after laparoscopic surgery, the incidence of those after hysterectomy was 9.2%. Anesthesia is one of the independent risk factors of postoperative ileus. Dexmedetomidine has been widely used in perioperative anesthesia and previous reports suggested that intraoperative dexmedetomidine may be associated with the improvement of gastrointestinal function recovery after abdominal surgery. We hypothesized that dexmedetomidine could improve gastrointestinal function recovery after laparoscopic hysteromyomectomy. Participants in elective laparoscopic hysteromyomectomy were enrolled with a single dose of 0.5 μg kg−1 dexmedetomidine or the same volume of placebo intravenously administered for 15 min, followed by continuous pumping of 0.2 μg kg−1 h−1 of corresponding drugs until 30 min before the end of surgery. The primary outcome was the time to first flatus. Secondary outcomes were the time to first oral feeding and the first defecation, the occurrence of flatulence, pain score and postoperative nausea and vomiting until 48 h after the surgery. Eventually, 106 participants (54 in dexmedetomidine group and 52 in placebo group) were included for final analysis. The time to first flatus (SD, 25.83 [4.18] vs 27.67 [3.77], P = 0.019), oral feeding time (SD, 27.29 [4.40] vs 28.92 [3.82], P = 0.044), the time to first defecation (SD, 59.82 [10.49] vs 63.89 [7.71], P = 0.025), abdominal distension (n%, 12 (22.2) vs 21 (40.4), P = 0.044), PONV at 24 h (n%, 10 (18.5) vs 19 (36.5), P = 0.037), NRS 6 h (3.15(0.68) vs 3.46 (0.87), P = 0.043) and NRS 12 h (3.43 (0.88) vs 3.85 (0.85), P = 0.014) of dexmedetomidine group were significantly shorter than those of the placebo group. Intraoperative dexmedetomidine reduced the time to first flatus, first oral feeding, and first defecation. These results suggested that this treatment may be a feasible strategy for improving postoperative gastrointestinal function recovery in patients undergoing laparoscopic hysteromyomectomy.

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“…In the group of recurrent jaundice, one patient's jaundice recurred just after bowel obstruction. One earlier study reported that the onset of bowel obstruction suggested a poor prognosis 17 . In 5 of the cases without an evident trigger, the DB had never reached a normal range.…”

Section: Discussionmentioning

confidence: 99%

Postoperative course and indications for liver transplantation in biliary atresia: 20 years of experience in our hospital

Sumida

Shirota

Tainaka

et al. 2023

Preprint

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Undergoing a Kasai portoenterostomy (KP) to enable the clearing of jaundice (COJ) is the only way for patients with biliary atresia (BA) to achieve native liver survival (NLS). However, COJ does not always guarantee NLS. We retrospectively reviewed the clinical course and indications for liver transplantation (LT) of BA cases in our hospital. We reviewed the clinical course of patients who underwent KP for BA at our hospital from January 2003 to June 2022 and who were followed up until December 2022. In all, we reviewed 129 cases of which 32 failed to achieve COJ, and 31 underwent LT. COJ was achieved in 97 cases. The median time to the first KP was 58 days, which was significantly earlier than the median time of 69 days of the cases who failed COJ. Of the 97 cases who achieved COJ, 25 required LT. The indications for LT included recurrent jaundice (9 cases), cholangitis (8 cases), gastrointestinal bleeding (4 cases), hepatopulmonary syndrome (3 cases), and the other (1 case). Of all cases reviewed, 55% of cases were able to live with their native liver, and 26% of cases who achieved COJ required LT.

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Postoperative intestinal obstruction in patients with biliary atresia impedes biliary excretion and results in subsequent liver transplantation

Cited by 5 publications

References 11 publications

Adding a spur valve to laparoscopic portoenterostomy for patients with biliary atresia can achieve a high jaundice clearance rate and lower the number of episodes of cholangitis

Adding a spur valve to laparoscopic portoenterostomy for patients with biliary atresia can achieve a high jaundice clearance rate and lower the number of episodes of cholangitis

Impact of intravenous dexmedetomidine on gastrointestinal function recovery after laparoscopic hysteromyomectomy: a randomized clinical trial

Postoperative course and indications for liver transplantation in biliary atresia: 20 years of experience in our hospital

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