Abstract
Purpose
This study was conducted to reappraise the efficacy of redo-Kasai (or revision) in the era of liver transplantation as a treatment option in those patients with recurrent jaundice after initially successful Kasai procedure.
Methods
We studied ten patients that received redo-Kasai, among a total of 102 patients diagnosed with biliary atresia after receiving Kasai operation from 1986 to 2011.
Results
Kasai operation was done at a median age of 55 days and redo-Kasai at 150 days. The bilirubin levels returned to normal in six patients after the procedure. Four of six enjoyed jaundice-free survival with native liver till the time of last follow-up. Three patients died and three received liver transplantation (LT). Only one out of seven patients with three or more episodes of cholangitis survived with native liver, while all the three patients with 1 or 0 episode survived with native liver. The difference was significant (P = 0.033). Re-do Kasai did not result in more blood loss or operative time during LT.
Conclusion
Redo-Kasai is still valuable in the era of LT and the episodes of cholangitis are the decisive factors affecting the outcome of the procedure.
References
Ricardo S, Jhoh M, Mary et al (2011) The anatomic pattern of biliary Atresia identified at time of Kasai hepatoportoenterostomy and early postoperative clerarance of jaundice are significant predictors of transplant-free survival. Ann Surg 254:577–585
Tiao MM, Chuang JH, Huang LT et al (2007) Management of biliary atresia: experience in a single institute. Chang Gung Med J 30:122–127
Chuang JH, Lin JN (2001) Biliary atresia at the dawn of a new century. Chang Gung Med J 24:217–228
Chuang JH, Lee SY, Shieh CS et al (2000) Reappraisal of role of the bilioenteric conduct in the pathogenesis of post operative cholangitis. Pediatr Surg Int 16:29–34
Kasai M, Suzuki S (1959) A new operation for “non-correctable” biliary atresia—portoenterostomy. Shijitsu 13:733–739
Mack CL, Sokol RJ (2005) Unraveling the pathogenesis and etiology of biliary atresia. Pediatr Res 57:87R–94R
Wildhaber BE, Majno P, Mayr J et al (2008) Biliary atresia: Swiss national study, 1994–2004. J Pediatr Gastroenterol Nutr 46:299–307
Chuang JH, Chen WJ, Lee SY et al (1998) Prompt colonization of the hepaticojejunostomi and translocation of bacteria to liver after bile duct reconstruction. J Pediatric Surg 33:1215–1218
Altman P, Anderson D (1982) Surgical management of intractable cholangitis following successful Kasai procedure. J Pediatr Surg 17:894–900
Saito S, Tsuchida Y, Homma T (1984) Reoperation for biliary atresia after hepatic portoenterostomy—experience in 29 cases with a report on the longest survivor in Japan. Z kindrchir 39:99–101
Ohi R, Hanamatsu M, Mochizuki I et al (1985) Reoperation in patients with biliary atresia. J Pediatr Surg 20:256–259
Hata Y, Uchino J, Kasai Y (1985) Revision of porto-enterostomy in congenital biliary atresia. J Pediatric Surg 20:217–220
Sugawara Y, Makuuchi M, Kaneko J et al (2004) Impact of previous multiple portoenterostomies on living donor liver transplantation for biliary atresia. Hepatogastroenterology 51:192–194
Bondoc AJ, Taylor JA, Alonso MH et al (2012) The beneficial impact of revision of Kasai portoenterostomy form biliary atresia: an institutional study. Ann Surg 255:570–576
Chen CL, Consejero A, Wang CC et al (2006) Living donor liver transplantation for biliary atresia: a single-center experience with first 100 cases. Am J Transplant 6:2672–2679
Wood RP, Langnas AN, Stratta RJ et al (1990) Optimal therapy for patients with biliary atresia: portoenterostomy (“Kasai” procedures) versus primary transplantation. J Pediatr Surg 25:153–160 (discussion 160–162)
Ohi R (2000) Biliary atresia. A surgical perspective. Clin Liver Dis 4:779–804
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Mendoza, M.M., Chiang, JH., Lee, SY. et al. Reappraise the effect of redo-Kasai for recurrent jaundice following Kasai operation for biliary atresia in the era of liver transplantation. Pediatr Surg Int 28, 861–864 (2012). https://doi.org/10.1007/s00383-012-3154-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-012-3154-y