Current management of biliary atresia based on 35 years of experience at a single center

Authors

  • Wagner de Castro Andrade Universidade de Sao Paulo. Faculdade de Medicina. Unidade Pediatrica de Transplante de Figado e Laboratorio de Pesquisa em Cirurgia Pediatrica
  • Marcos Marques Silva Universidade de Sao Paulo. Faculdade de Medicina. Unidade Pediatrica de Transplante de Figado e Laboratorio de Pesquisa em Cirurgia Pediatrica
  • Ana Cristina Aoun Tannuri Universidade de Sao Paulo. Faculdade de Medicina. Unidade Pediatrica de Transplante de Figado e Laboratorio de Pesquisa em Cirurgia Pediatrica
  • Maria Merces Santos Universidade de Sao Paulo. Faculdade de Medicina. Unidade Pediatrica de Transplante de Figado e Laboratorio de Pesquisa em Cirurgia Pediatrica
  • Nelson Elias Mendes Gibelli Universidade de Sao Paulo. Faculdade de Medicina. Unidade Pediatrica de Transplante de Figado e Laboratorio de Pesquisa em Cirurgia Pediatrica
  • Uenis Tannuri Universidade de Sao Paulo. Faculdade de Medicina. Unidade Pediatrica de Transplante de Figado e Laboratorio de Pesquisa em Cirurgia Pediatrica

DOI:

https://doi.org/10.6061/clinics/2018/e289

Keywords:

Biliary Atresia/Surgery, Hepatic Portoenterostomy, Survival Rate, Liver Transplantation, Neonatal

Abstract

Biliary Atresia/SurgeryOBJECTIVE: The prognosis of patients with biliary atresia undergoing Kasai portoenterostomy is related to the timing of the diagnosis and the indication for the procedure. The purpose of the present study is to present a practical flowchart based on 257 children who underwent Kasai portoenterostomy. METHODS: We conducted a retrospective cohort study of patients who underwent Kasai portoenterostomy between 1981 and 2016. RESULTS: During the first period (1981 to 2009), 230 infants were treated, and the median age at the time of surgery was 84 days; jaundice was resolved in 77 patients (33.5%). During the second period, from 2010 to 2016, a new diagnostic approach was adopted to shorten the wait time for portoenterostomy; an ultrasonography examination suggestive of the disease was followed by primary surgical exploration of the biliary tract without complementary examination or liver biopsy. Once the diagnosis of biliary atresia was confirmed, a portoenterostomy was performed during the same surgery. During this period, 27 infants underwent operations; the median age at the time of surgery was 66 days (po0.001), and jaundice was resolved in 15 patients (55.6% - p=0.021), with a survival rate of the native liver of 66.7%. CONCLUSION: Primary surgical exploration of the biliary tract without previous biopsy was effective at improving the prognostic indicators of patients with biliary atresia undergoing Kasai portoenterostomy.

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Published

2019-02-13

Issue

Section

Original Articles

How to Cite

Current management of biliary atresia based on 35 years of experience at a single center. (2019). Clinics, 73, e289. https://doi.org/10.6061/clinics/2018/e289