Clinical outcomes and influencing factors of reoperation in biliary atresia
Jiawei Zhao1, Wei Chen1, Xianhua Hao1
1Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, 168 LiTang Road, 102200, Beijing, China.
Background:
To investigate the clinical characteristics and prognosis of patients with biliary atresia (BA) who undergo reoperation after initial Kasai portoenterostomy, and to evaluate the feasibility and clinical value of the reoperation.
Methods:
We retrospectively analyzed the clinical data of 19 patients with BA who underwent reoperation at Beijing Tsinghua Changgung Hospital from August 2022 to September 2025. Data collected included age at initial Kasai, jaundice clearance status after the first surgery, preoperative liver function and imaging findings, and reoperation techniques. Follow-up was conducted via outpatient visits, telephone calls, or WeChat. The primary outcome was anicteric native liver survival (total bilirubin < 2.0 mg/dL). Clinical characteristics and prognosis were analyzed.
Results:
The median age at the initial Kasai and reoperation was 59 and 320 days. Of the 19 patients, 12 achieved jaundice clearance after the first surgery. Preoperative imaging before reoperation revealed intrahepatic cystic anechoic areas in 12 patients. Surgical techniques included intrahepatic cyst-jejunostomy (n = 8), re-anastomosis after resection of residual fibrous mass (n = 8), and hepatic duct enlargement plasty with re-anastomosis (n = 3). At a median follow-up of 494 days, eight patients (42.1%) maintained anicteric native liver survival. Univariate analysis identified initial postoperative jaundice clearance as the only significant prognostic factor (P = 0.013). Kaplan-Meier survival analysis showed that the two-year anicteric native liver survival rate after reoperation was 70.7% in the clearance group (median not reached), whereas the non-clearance group had a median survival of only 1.342 years, with a significant between-group difference in survival (χ²=6.572, p = 0.010).
Conclusion:
Successful initial postoperative jaundice clearance is a critical prognostic indicator for reoperation in BA. Reoperation effectively prolongs anicteric native liver survival in patients with prior clearance but recurrent jaundice, whereas it offers limited benefit to those without initial clearance, who should be prioritized for liver transplantation assessment.