Abstract
Cholangitis is the most common complication in patients after Kasai portoenterostomy, with an incidence of 30% to 70%. Patients with early bile drainage after Kasai operation are more vulnerable to cholangitis. Early cholangitis and recurrent cholangitis are interrelated and can contribute to reduced overall survival.
The pathogenesis of postoperative cholangitis is still controversial, but one potential cause of cholangitis is ascending intestinal bacteria.
Postoperative cholangitis characterized by fever and acholic stool and positive blood culture is a common and serious complication following Kasai operation for biliary atresia. No modification prevented cholangitis more effectively than the original KP. Consequently, most pediatric surgeons currently use the original KP procedure with a long Rou-en Y loop. Recommendation is to administer the antibiotics intravenously for 2 to 4 weeks after surgery, followed by oral antibiotics.
Individualized treatment considering risk factors for individual BA patients should be strongly considered to prevent cholangitis.
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References
Qiao G, Li L, Cheng W, et al. Conditional probability of survival in patients with biliary atresia after Kasai portoenterostomy: a Chinese population-based study. J Pediatr Surg. 2015;50(8):1310–5.
Gunadi GTA, Widiyanto G, et al. Liver transplant score for prediction of biliary atresia patients’ survival following Kasai procedure. BMC Res Notes. 2018;11(1):381.
Jiang H, Gao PF, Chen HD, et al. The prognostic value of CD8(+) and CD45RO (+) T cells infiltration and Beclin1 expression levels for early postoperative cholangitis of biliary atresia patients after Kasai operation. J Korean Med Sci. 2018;33(30):e198.
Koga H, Wada M, Nakamura H, et al. Factors influencing jaundice-free survival with the native liver in post-portoenterostomy biliary atresia patients: results from a single institution. J Pediatr Surg. 2013;48(12):2368–72.
Nio M, Wada M, Sasaki H, et al. Risk factors affecting late-presenting liver failure in adult patients with biliary atresia. J Pediatr Surg. 2012;47:2179–83.
Muraji T, Tsugawa C, Nishijima E, et al. Surgical management for intractable cholangitis in biliary atresia. J Pediatr Surg. 2002;37:1713–5.
Chen SY, Lin CC, Tsan YT, et al. Number of cholangitis episodes as a prognostic marker to predict timing of liver transplantation in biliary atresia patients after Kasai portoenterostomy. BMC Pediatr. 2018;18(1):119.
Ernest VHL, Saing H, Tam PK. Cholangitis after hepatic portoenterostomy for biliary atresia: a multivariate analysis of risk factors. J Pediatr. 2003;142(5):566–71.
Li D, Wang P, He Y, et al. Intravenous immunoglobulin for the treatment of intractable cholangitis after Kasai portoenterostomy in biliary atresia patients. Pediatr Surg Int. 2018;34(4):399–404.
Nakajima H, Koga H, Okawada M, et al. Does time taken to achieve jaundice- clearance influence survival of the native liver in post-Kasai biliary atresia? World J Pediatr. 2018;14(2):191–6.
Ohi R, Ibrahim M. Biliary atresia. Semin Pediatr Surg. 1992;1:115–24.
Japanese Biliary Atresia Society. Japanese biliary atresia registry 2018. J Jpn Soc Pediatr Surg. 2020;56:219–25. [in Japanese]
Nio M, Ohi R, Miyano T, et al. Five-and10-yearsurvivalratesaftersurgeryforbiliary atresia: a report from the Japanese biliary atresia registry. J Pediatr Surg. 2003;38:997–1000.
Nio M, Wada M, Sasaki H, et al. Technical standardization of Kasai portoenterostomy for biliary atresia. J Pediatr Surg. 2016;51:2105–8.
Ando H, Ito T, Nagaya M. Use of external conduit impairs liver function in patients with biliary atresia. J Pediatr Surg. 1996;31:1509–11.
Nio M, Sasaki H, Tanaka H, et al. Redo surgery for biliary atresia. Pediatr Surg Int. 2013;29:989–93.
Sartorelli KH, Holland RM, Allshouse MJ, et al. The intussusception antireflux valve is ineffective in preventing cholangitis in biliary atresia. J Pediatr Surg. 1996;31(3):403–6.
Komuro H, Makino S, Momoya T, et al. Cholangitis associated with cystic dilatation of the intrahepatic bile ducts after antireflux valve construction in biliary atresia. Pediatr Surg Int. 2001;17:108–10.
Ogasawara Y, Yamataka A, Tsukamoto K, et al. The intussusception antirefluxvalve is ineffective for preventing cholangitis in biliary atresia: a prospective study. J Pediatr Surg. 2003;38(12):1826–9.
Nichol PF, Adzick NS. Gallstone ileus 20 years after a Kasai procedure using a stapled antireflux valve. J Pediatr Surg. 2007;42(1):264–6.
Ono S, Nagayasu K, Niwa K, et al. A case of small bowel torsion after biliary atresia operation with intussusception antireflux valve. Nihonfukubukyukyuigakukaizashi. 2011;31(5):807–10. [in Japanese]
Higashimoto Y, Saitoh T, Kaneda H, et al. Evidence-based antimicrobial therapy for cholangitis in patients with biliary atresia. Jpn J Pediatr Surg. 2008;40(1):93–101. [in Japanese]
de Vries W, de Langen ZJ, Groen H, et al. Biliary atresia in the Netherlands: outcome of patients diagnosed between 1987 and 2008. J Pediatr. 2012;160(4):638–44.
Meyers RL, Book LS, O’Gorman MA, et al. High-dose steroids, ursodeoxycholic acid, and chronic intravenous antibiotics improve bile flow after Kasai procedure in infants with biliary atresia. J Pediatr Surg. 2003;38(3):406–11.
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Maeda, K. (2021). Current Concept About Prevention/Treatment of Postoperative Cholangitis. In: Nio, M. (eds) Introduction to Biliary Atresia. Springer, Singapore. https://doi.org/10.1007/978-981-16-2160-4_28
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DOI: https://doi.org/10.1007/978-981-16-2160-4_28
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