Skip to main content
Log in

Reappraise the effect of redo-Kasai for recurrent jaundice following Kasai operation for biliary atresia in the era of liver transplantation

Pediatric Surgery International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. 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

    Article  Google Scholar 

  2. 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

    PubMed  Google Scholar 

  3. Chuang JH, Lin JN (2001) Biliary atresia at the dawn of a new century. Chang Gung Med J 24:217–228

    PubMed  CAS  Google Scholar 

  4. 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

    Article  PubMed  CAS  Google Scholar 

  5. Kasai M, Suzuki S (1959) A new operation for “non-correctable” biliary atresia—portoenterostomy. Shijitsu 13:733–739

    Google Scholar 

  6. Mack CL, Sokol RJ (2005) Unraveling the pathogenesis and etiology of biliary atresia. Pediatr Res 57:87R–94R

    Article  PubMed  Google Scholar 

  7. Wildhaber BE, Majno P, Mayr J et al (2008) Biliary atresia: Swiss national study, 1994–2004. J Pediatr Gastroenterol Nutr 46:299–307

    Article  PubMed  Google Scholar 

  8. 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

    Article  CAS  Google Scholar 

  9. Altman P, Anderson D (1982) Surgical management of intractable cholangitis following successful Kasai procedure. J Pediatr Surg 17:894–900

    Article  PubMed  CAS  Google Scholar 

  10. 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

    CAS  Google Scholar 

  11. Ohi R, Hanamatsu M, Mochizuki I et al (1985) Reoperation in patients with biliary atresia. J Pediatr Surg 20:256–259

    Article  PubMed  CAS  Google Scholar 

  12. Hata Y, Uchino J, Kasai Y (1985) Revision of porto-enterostomy in congenital biliary atresia. J Pediatric Surg 20:217–220

    Article  CAS  Google Scholar 

  13. 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

    PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. 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)

    Article  PubMed  CAS  Google Scholar 

  17. Ohi R (2000) Biliary atresia. A surgical perspective. Clin Liver Dis 4:779–804

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Shin-Yi Lee or Jiin-Haur Chuang.

Rights and permissions

Reprints 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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-012-3154-y

Keywords

Navigation