Redo Kasai portoenterostomy in biliary atresia

Redo Kasai portoenterostomy (KPE) remains a controversial surgical option in biliary atresia (BA). In response to Zhao et al., we contextualize this procedure within the international literature. Data from the Japanese Biliary Atresia Registry and clinical practice guidelines consistently indicate that the optimal candidate is the patient who achieved initial jaundice clearance followed by subsequent deterioration. Before proceeding with reoperation, a trial of corticosteroid therapy, which exerts choleretic and anti-inflammatory effects targeting the intrahepatic compartment, may be considered. Critically, redo-KPE cannot address the progressive intrahepatic cholangiopathy that ultimately drives disease in BA. Patient selection, corticosteroid optimization, and timely referral for liver transplantation remain the cornerstones of management.