Factors Related to the Clinical Outcomes of the Kasai Procedure in Infants with Biliary Atresia

Mongkol  Laohapensang; Patcharaphan  Srikuancharoen; Niramol    Tantemsapya

doi:10.33192/Smj.2020.31

Authors

Mongkol Laohapensang Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 http://orcid.org/0000-0002-0774-5705
Patcharaphan Srikuancharoen Department of Surgery, Chaophraya Yommaraj Hospital, Suphanburi https://orcid.org/0000-0002-2847-9944
Niramol Tantemsapya Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 http://orcid.org/0000-0003-3886-6793

DOI:

https://doi.org/10.33192/Smj.2020.31

Keywords:

Adjuvant therapy, biliary atresia, cholangitis, Kasai portoenterostomy outcome, prophylactic antibiotic

Abstract

Objective: The Kasai portoenterostomy has been accepted as the primary therapeutic treatment for biliary atresia. However, successful bile drainage does not always promise a long-term native liver survival. Several clinical factors were evaluated to discover associations with the outcomes.
Methods: A retrospective chart review was conducted of infants with biliary atresia who underwent the conventional Kasai portoenterostomy at Siriraj Hospital, January 2006-August 2018. The patient demographics, perioperative clinical and laboratory data, adjuvant therapies, complications, and interventions were analyzed in correlation to the short- and long-term outcomes. The short-term outcome evaluated was the resolution of jaundice, while the long-term outcome was remaining jaundice-free with the native liver.
Results: The complete medical records of 80 patients were retrospectively reviewed. Their mean age at the time of the Kasai portoenterostomies was 97 days. Overall, 66.3% achieved jaundice clearance. The mean follow-up duration was 50.5 months, with 51.3% of the patients remaining jaundice-free with their native liver. A prolonged duration of a prophylactic antibiotic was significantly related to the jaundice clearance, with a p-value of 0.002. Moreover, a lower number of episodes of cholangitis was significantly related to a good long-term outcome (p-value, 0.024).
Conclusion: The prolonged provision of a prophylactic antibiotic as adjuvant therapy after the Kasai portoenterostomy was associated with jaundice clearance. An increased incidence of cholangitis episodes was associated with poor long-term outcomes. Postoperative adjuvant therapy should be standardized and maintained for the care of biliary atresia patients to improve their outcomes.

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