Prof. Shilpa Sharma - Best of the Best in Pediatric Surgery 2024
▶Ep 17 · 1:06
quoteBiliary atresia is a dreadful disease with no definite cure.↗
▶Ep 17 · 1:06
clinicalBiliary atresia is a progressive cholangiopathy that leads to morbidity and end stage cirrhosis.↗
▶Ep 17 · 1:10
epidemiologicalIn developing countries with delayed presentation, advanced cirrhosis, and hepatic failure, most infants with biliary atresia succumb to hepatopulmonary syndrome, portal hypertension, intraventricular hemorrhage, and aspiration due to massive ascites.↗
▶Ep 17 · 1:33
clinicalThe liver may regenerate after physiological insults and resection, with hepatic resection acting as a trigger for regeneration.↗
▶Ep 17 · 1:41
quoteThe liver, however, can regenerate only to a size that is proportional to its original size.↗
▶Ep 17 · 1:41
clinicalThe liver can regenerate only to a size that is proportional to its original size.↗
▶Ep 17 · 1:53
clinicalIn biliary atresia, hepatic stellate cells activate and lead to a pro-fibrogenic pathway involving transforming growth factor, platelet derived growth factor, and interleukins.↗
▶Ep 17 · 2:09
clinicalIn hepatic resection, hematopoietic stem cells lead to proliferation with the help of hepatocyte growth factor receptor, epidermal growth factor receptor, and cytokines like tumor necrosis factor.↗
▶Ep 17 · 2:26
clinicalStarting in 2015, the team began resecting segments 2 and 3 of the liver in a non-anatomical fashion to stimulate an alternative pathway of stem cell proliferation for hepatic regeneration.↗
▶Ep 17 · 2:45
clinicalThe study compared outcomes of segmentectomy combined with Kasai procedure versus Kasai alone, measuring bilirubin and APRI at preoperative, day 7, and 1st, 3rd, 6th, and 12th month time points.↗
▶Ep 17 · 3:16
clinicalThe median age at presentation was similar in both groups: 96 days in one group and 89 days in the other.↗
▶Ep 17 · 3:26
clinicalSerum bilirubin levels were significantly different between the Kasai-plus-resection group and Kasai-alone group at 1 month and 3 months postoperatively.↗
▶Ep 17 · 3:35
clinicalAPRI (AST to Platelet Ratio Index) was significantly different between groups on postoperative day 7.↗
▶Ep 17 · 3:41
clinicalMortality was lower in the study group (Kasai plus resection) at 56% compared to 93% in the control group (Kasai alone).↗
▶Ep 17 · 3:49
clinicalThe jaundice-free percentage was 91% in the study group compared to 25% in the control group.↗
▶Ep 17 · 3:58
opinionResection of a part of the liver may trigger an alternative pathway of stem cell proliferation for hepatic regeneration with reduced fibrosis and improved survival.↗