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The Kasai portoenterostomy: when is it too late?
B T Schoen1, H Lee, K Sullivan
1Departments of Gastroenterology and Surgery, Children's Healthcare of Atlanta at Egleston, Emory University, Atlanta, GA, USA.
Insights
Performing a Kasai portoenterostomy for biliary atresia in infants over 75 days old shows a high success rate. This late intervention for biliary atresia is a viable option, offering good outcomes.
Area of Science:
- Pediatric Surgery
- Hepatology
- Neonatal Care
Background:
- Extrahepatic biliary atresia requires timely Kasai portoenterostomy, ideally within 10-12 weeks of life.
- Optimal management for delayed biliary atresia presentation is debated.
- This study evaluates the efficacy of late Kasai portoenterostomy.
Purpose of the Study:
- To determine the success rate of Kasai portoenterostomy in infants presenting later than 12 weeks.
- To assess long-term outcomes, including liver transplantation and survival, after late Kasai portoenterostomy.
- To analyze the relationship between age at surgery and patient outcomes.
Main Methods:
- Retrospective review of 31 biliary atresia patients undergoing Kasai portoenterostomy (1986-1999).
- Analysis of surgical success (total serum bilirubin ≤ 2 mg/dL) based on age at procedure.
- Evaluation of liver transplant rates and patient survival.
Main Results:
- A higher success rate (83%) was observed in patients aged 76 days or older compared to those aged 0-75 days (52%).
- Liver transplantation was required in 45% of patients.
- Overall survival was 74%, with 39% alive without transplantation.
Conclusions:
- Kasai portoenterostomy is a viable treatment option for biliary atresia even when performed after 75 days of age.
- Delayed Kasai portoenterostomy does not appear to be contraindicated.
- The study supports considering late Kasai portoenterostomy for eligible patients.
Background/Purpose:
Kasai portoenterostomy is recommended as the primary initial therapy for extrahepatic biliary atresia if the procedure can be performed within 10 to 12 weeks of life. The optimal management for infants with delayed presentation of biliary atresia remains controversial. The purpose of this study was to determine the success rate and outcome for patients who underwent a "late" Kasai portoenterostomy.
Methods:
The authors conducted a retrospective review of the medical records of all patients with biliary atresia who underwent a Kasai portoenterostomy at their institution from 1986 to 1999 (n = 31). The authors analyzed success rates compared with age at the time of the Kasai procedure and the association with patient demographics. Surgical success was defined as achievement of a total serum bilirubin < or = 2 mg/dL. Long-term follow-up assessments included the need for liver transplantation and patient survival rate.
Results:
The demographics of this study cohort showed a predominance of African-Americans, 19 of 31 (61%), and girls, 23 of 31 (74%). Assessment of success compared with subject age at the time of the initial portoenterostomy showed that 52% (13 of 25) had successful Kasai procedure at 0 to 75 days, compared with 83% success rate (5 of 6) at age 76 days or older (P = .359). Liver transplantation was performed in 16 of 31 patients (45%). Overall survival rate for the entire cohort is 23 of 31 (74%), whereas 12 of 31 (39%) are currently alive without a liver transplant.
Conclusion:
These data suggest that there is no contraindication to performing a Kasai portoenterostomy for biliary atresia in children over 75 days of age.