Mid-term outcome of postoperative biliary atresia patients according to level of transection of the biliary remnant and depth of suturing
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In brief
In brief
Comparative study of 55 biliary atresia patients shows modified portoenterostomy with shallow transection and suturing achieved significantly better jaundice-free native liver survival (70.2%) versus extended technique (22.2%). Modified approach demonstrated higher bile lake incidence requiring further investigation.
Written by the GCMD Library team from the article.
Abstract
Purpose
Open portoenterostomy (PE) for biliary atresia (BA) is currently more extended (EP) than the original (OP). Typical OP techniques, shallow transection of the biliary remnant and shallow suturing, both lost in EP, were revived as a modified procedure (MP). Postoperative outcomes of EP and MP were compared.
Methods
Subjects were 55 consecutive BA patients treated by EP (n = 18) or MP (n = 37) at a single center between 2004 and 2021.
Results
Mean follow-up duration was: MP: 15.5 years (range 0.1–12.3 years) and EP: 15.5 years (range 0.38–17.1 years). The ratio of jaundice free (JF; total bilirubin ≤ 1.2 mg/dL) subjects was significantly higher in MP (78.4%) versus EP (50%); p > 0.05, the incidence of bile lakes at the porta hepatis was significantly higher in MP (7/37: 18.9%) versus EP (0/18: 0%); p > 0.05, and Kaplan–Meier analysis showed JF survival with the native liver (JF + SNL) was significantly better in MP (26/37: 70.2%) versus EP (4/18: 22.2%); p > 0.05. All other criteria were similar. Of note, time taken to become JF and the incidence of cholangitis were not significantly different.
Conclusions
Shallow transection and shallow suturing would appear to influence postoperative outcome. The etiology of bile lake formation in MP requires urgent confirmation.