Post-portoenterostomy triangular cord sign prognostic value in biliary atresia: a prospective study

Area of Science:

• Pediatric Surgery
• Diagnostic Imaging
• Hepatobiliary Diseases

Background:

• Extrahepatic biliary atresia requires prompt diagnosis and surgical intervention.
• The triangular cord sign (TC sign) is a recognized ultrasound marker for diagnosing biliary atresia pre-operatively.
• The prognostic value of the post-operative TC sign following Kasai hepato-portoenterostomy remains to be fully elucidated.

Purpose of the Study:

• To assess the utility of the post-operative triangular cord sign (TC sign) in predicting outcomes for infants with biliary atresia.
• To correlate post-operative TC sign presence with surgical success and patient prognosis after Kasai hepato-portoenterostomy.

Main Methods:

• A cohort of 27 infants and children with biliary atresia were followed for 33 months.
• 122 ultrasound examinations were performed using 5 MHz and 7 MHz transducers.
• TC sign assessment was conducted pre-operatively and at multiple intervals post-Kasai hepato-portoenterostomy.

Main Results:

• Post-operative TC sign was identified in 53.8% of patients and remained persistently positive.
• Infants with a positive post-operative TC sign exhibited significantly worse outcomes, including increased progressive disease and mortality (p=0.04).
• Persistent post-operative TC sign correlated with incomplete removal of the fibrous cone at the porta-hepatis during surgery (p=0.026).

Conclusions:

• The post-operative triangular cord sign (TC sign) is a valuable indicator of unfavorable outcomes in biliary atresia patients post-Kasai hepato-portoenterostomy.
• A persistent post-operative TC sign suggests inadequate surgical technique and is associated with increased morbidity and mortality.
• Routine post-operative ultrasound for TC sign evaluation can aid in predicting patient prognosis.