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Advanced biliary atresia: is portoenterostomy justified in all infants?
1Department of Pediatrics Surgery, All India Institute of Medical Sciences, New Delhi-110029, India. devendra6@hotmail.com
Insights
Sump drainage is a viable alternative to hepatico-portoenterostomy (HPE) for advanced biliary atresia (ABA). This method aids in evaluating bile flow and reduces complications compared to HPE.
Area of Science:
- Pediatric Surgery
- Hepatology
Background:
- Biliary atresia (BA) is a serious neonatal liver disease.
- Advanced biliary atresia (ABA) presents challenges due to late diagnosis, cirrhosis, and portal hypertension.
Purpose of the Study:
- To evaluate sump drainage as an alternative to hepatico-portoenterostomy (HPE) in infants with advanced biliary atresia.
- To assess the efficacy of sump drainage in determining bile flow and its impact on patient outcomes.
Main Methods:
- A retrospective study comparing 23 patients with advanced biliary atresia.
- Group I (n=16): Underwent exploratory laparotomy, porta hepatis dissection, and HPE.
- Group II (n=7): Underwent portal dissection and sump drainage only, with HPE considered if bile flow was observed.
Main Results:
- Bile flow was observed in 3/16 patients in Group I and 0/7 in Group II.
- A decrease in serum bilirubin was noted in 2/16 patients in Group I and none in Group II.
- Group I patients experienced a significantly higher incidence of complications and longer hospital stays.
Conclusions:
- Sump drainage serves as an effective method for evaluating potential bile flow in advanced biliary atresia.
- Sump drainage can potentially avoid the need for major surgery like HPE in select cases.
- This approach may reduce complications and hospital stay duration for patients with advanced biliary atresia.
Abstract:
During 1989-98, of the 127 patients with biliary atresia, 23 were seen with advanced biliary atresia (ABA) presenting with (i) at more than 120 days of age (ii) established cirrhosis and (iii) features of portal hypertension. Sixteen of these underwent exploratory laparotomy, dissection at the porta hepatis and hepatico-portoenterostomy (HPE) (group I). The remaining 7 infants underwent portal dissection and sump drainage only (instead of HPE). The drainage if any was evaluated for any change in colour, volume and concentration in the post-operative period (group II). Age and presentation were the same in both the groups. In group-II, HPE was considered only if the bile flow was noted after portal dissection. Bile flow was seen in 3/16 in group I and 0/7 in group II. The fall in serum bilirubin during the first seven post operative days was noted in 2/16 in group I and 0/7 in group II. No drain output was recorded in any of the group II infants. The incidence of complications and the duration of hospital stay was significantly higher in group I patients. The sump drainage as an alternative procedure to HPE not only served the purpose of evaluating the patients with ABA for the possible bile flow in the post operative period but also avoided the need for a major operative procedure like HPE.