Current management of biliary atresia based on 35 years of experience at a single center
| Autor: | Nelson Elias Mendes Gibelli, Ana Cristina Aoun Tannuri, Marcos Marques da Silva, Uenis Tannuri, Maria Mercês Santos, Wagner de Castro Andrade |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
Neonatal Jaundice medicine.medical_specialty Time Factors Biliary Atresia/Surgery medicine.medical_treatment Hepatic Portoenterostomy Portoenterostomy Hepatic Kaplan-Meier Estimate Liver transplantation Single Center TRANSPLANTE DE FÍGADO 03 medical and health sciences 0302 clinical medicine Biliary atresia Biliary Atresia Neonatal 030225 pediatrics Medicine Humans Survival rate Retrospective Studies lcsh:R5-920 medicine.diagnostic_test business.industry Age Factors Infant Newborn Infant Retrospective cohort study General Medicine Jaundice medicine.disease Surgery Jaundice Neonatal Liver Transplantation Survival Rate Treatment Outcome Liver Biliary tract Liver biopsy 030211 gastroenterology & hepatology Original Article Female medicine.symptom business lcsh:Medicine (General) Brazil |
| Zdroj: | Clinics, Volume: 73, Article number: e289, Published: 10 JUL 2018 Clinics, Vol 73, Iss 0 (2018) Clinics Repositório Institucional da USP (Biblioteca Digital da Produção Intelectual) Universidade de São Paulo (USP) instacron:USP Clinics; v. 73 (2018); e289 Clinics; Vol. 73 (2018); e289 |
| ISSN: | 1980-5322 1807-5932 |
| Popis: | Biliary Atresia/SurgeryOBJECTIVE: The prognosis of patients with biliary atresia undergoing Kasai portoenterostomy is related to the timing of the diagnosis and the indication for the procedure. The purpose of the present study is to present a practical flowchart based on 257 children who underwent Kasai portoenterostomy. METHODS: We conducted a retrospective cohort study of patients who underwent Kasai portoenterostomy between 1981 and 2016. RESULTS: During the first period (1981 to 2009), 230 infants were treated, and the median age at the time of surgery was 84 days; jaundice was resolved in 77 patients (33.5%). During the second period, from 2010 to 2016, a new diagnostic approach was adopted to shorten the wait time for portoenterostomy; an ultrasonography examination suggestive of the disease was followed by primary surgical exploration of the biliary tract without complementary examination or liver biopsy. Once the diagnosis of biliary atresia was confirmed, a portoenterostomy was performed during the same surgery. During this period, 27 infants underwent operations; the median age at the time of surgery was 66 days (po0.001), and jaundice was resolved in 15 patients (55.6% - p=0.021), with a survival rate of the native liver of 66.7%. CONCLUSION: Primary surgical exploration of the biliary tract without previous biopsy was effective at improving the prognostic indicators of patients with biliary atresia undergoing Kasai portoenterostomy. |
| Databáze: | OpenAIRE |
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