Clinical utility of intraoperative wedge biopsies after preoperative core needle biopsies in biliary atresia

Pediatric surgeons often obtain intraoperative liver wedge biopsies during Kasai portoenterostomy for biliary atresia despite an existing preoperative core needle biopsy. We conducted a single-institution retrospective review analyzing preoperative factors, Batts-Ludwig fibrosis stage (preoperative percutaneous core needle and intraoperative wedge biopsies), and survival with native liver from 2004 to 2023. Of 116 patients, 87 underwent both preoperative and intraoperative biopsies, with discordant results observed in 30/87 (34.5 ​%) patients. Of the discordant samples, intraoperative wedge biopsies upstaged the Batts-Ludwig scoring system in 97 ​% of biopsies. Neither the core needle (p ​= ​0.80) nor wedge (p ​= ​0.18) fibrosis stage correlated with native liver survival at one year. Age at surgery (58 vs. 63 days, p ​= ​0.04), aspartate transferase (145 vs. 195 U/L, p ​= ​0.05), and alanine transferase (108 vs. 143 U/L, p ​= ​0.03) demonstrated associations with native liver survival at one year. Our data suggests that routine intraoperative wedge biopsies may not be necessary after preoperative core biopsies.