Outcomes of Kasai Operation for Treatment of Patients with Biliary Atresia at a Tertiary Care Hospital

Abstract

Background : Biliary atresia is an idiopathic fibroobliterative disease of extrahepatic biliary tree that presents with biliary obstruction exclusively in the neonatal period. The operation to restore bile flow from the liver to the small intestine is Kasai operation or hepatic portoenterostomy.

Objective : The aim of this study was to evaluate the clinical outcomes of patients with biliary atresia after Kasai operation in an 8-year period.

Methods : Medical records of the patients with biliary atresia underwent Kasai operation at Khon Kaen Hospital during January 2010 to December 2017 were reviewed. Demographic data, clinical presentations, investigation, operative procedure and outcomes were analyzed.

Results : Twenty-six patients (11 males and 15 females) with biliary atresia were treated during the study period. They presented with jaundice and acholic stool with median level of total bilirubin of 9.6 mg/dl. The triangular cord sign was revealed from ultrasonography in 23 of 25 cases (92.0%). DISIDA scan was done in 17 cases and showed no excretion of the radionucleotide in the intestine (100%). All of the 26 cases underwent Kasai operation at the median age of 90.5 days (range 35-171 days). Major postoperative complications were severe pneumonia and septicemia that were the causes of death in 6 cases (23.1%). Median level of total bilirubin was decreased to 6.9 and 5.1 mg/dl after 2-week postoperation and the last follow-up respectively. All of the 20 survivors were doing well with jaundice disappearance in 9 cases (45%).

Conclusion : Kasai operation is the principal procedure for creation of bile flow from the liver to the intestine. Major postoperative complications in this study were severe pneumonia and septicemia, especially occurring in the patients older than 3 months old at operation. Some cases had successful bile drainage until the jaundice was disappearance.