Short- and long-term outcomes after Kasai operation for type III biliary atresia: Twenty years of experience in a single tertiary Egyptian center-A retrospective cohort study.

Autor:	Gad EH; Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt., Kamel Y; Anaesthesia, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt., Salem TA; Pediatric Hepatology, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt., Ali MA; Pediatric Hepatology, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt., Sallam AN; Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt.
Jazyk:	angličtina
Zdroj:	Annals of medicine and surgery (2012) [Ann Med Surg (Lond)] 2021 Jan 23; Vol. 62, pp. 302-314. Date of Electronic Publication: 2021 Jan 23 (Print Publication: 2021).
DOI:	10.1016/j.amsu.2021.01.052
Abstrakt:	Kasai portoenterostomy(KPE) is the treatment of choice for the fatal devastating infantile type III biliary atresia (BA). The study aimed to analyze short-and long-term outcomes after this procedure and their predictors in a tertiary center. Methods: We retrospectively analyzed 410 infants who underwent KPE for type III BA in the period from February 2000 to December 2019. The overall male/female ratio was 186/224. Results: The early (>6months) complications involved 187(45.6%) of our infants with a higher incidence of early cholangitis that affected 108(26.3%) of them. The jaundice clearance at the 6th post-operative month that reached 138(33.7%) of them had an independent correlation with mild portal tracts ductal and/or ductular proliferation, using postoperative steroids therapy, and absence of early postoperative cholangitis. The early infant mortality that affected 70(17.1%) of our patients was mostly from sepsis. On the other hand, late (<6months) patients complications and mortalities affected 256(62.4%) and 240(58.5%) of patients respectively; moreover, liver failure and sepsis were the most frequent causes of late mortalities in non-transplanted and transplanted cases respectively. Lastly, the long-term (20-year) native liver survival (NLS) that reached 91(22.2%) of patients had an independent correlation with age at operation ≤ 90 days, higher preoperative mean serum alb, portal tract fibrosis grades F0 and F1, absence of intraoperative bleeding, absence of post-operative cholangitis, the occurrence of jaundice clearance at the 6th postoperative month and absence of post-operative portal hypertension (PHN). Conclusions: Sepsis had a direct effect on early and late patient mortalities after Kasai operation for type III BA; moreover, patient age at operation<90 days, higher fibrosis grades, the occurrence of postoperative cholangitis and PHN, and persistence of post-operative jaundice had negative insult on long-term postoperative outcome. So, it is crucial to modulate these factors for a better outcome. Competing Interests: No conflict of interest to declare. (© 2021 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)
Databáze:	MEDLINE
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