Current Management of Long-term Survivors of Biliary Atresia: over 40 years of Experience in a Single Center and Review of the Literature

Overview

Journal Pediatr Surg Int

Specialties General Surgery
Pediatrics

Date 2017 Sep 29

PMID 28956136

Citations 8

Authors

Hideyuki Sasaki

Hiromu Tanaka

Masaki Nio

Affiliations

Soon will be listed here.

Abstract

Introduction: Owing to several therapeutic advancements, more patients with biliary atresia now survive into adulthood while retaining their native liver. However, the optimal strategy for long-term management of such patients remains unclear.

Methods: Aiming to establish the current management strategies, we reviewed previous reports of long-term outcome of BA who underwent surgery at our institution as well as the relevant literature, focusing particularly on the treatment of late complications.

Results: Approximately 30-40% of long-term survivors of biliary atresia who retain their native liver exhibit late sequelae such as cholangitis and portal hypertension. Early and appropriate intervention with Kasai portoenterostomy is essential for ensuring long-term survival with good quality of life. In our hospital, the current standard for Kasai portoenterostomy involves dissecting the fibrous remnants along the porta hepatis, just on the level of the liver capsule. Cholangitis is an important late complication in biliary atresia, and the possibility of mechanical obstruction of the biliary drainage route or deformity of the intrahepatic bile ducts with or without gallstones should be thoroughly evaluated in patients with intractable cholangitis. Regarding portal hypertension, appropriate interventions such as endoscopic variceal treatment and partial splenic embolization are considered to provide good quality of life when hepatic function is preserved.

Conclusion: Appropriate therapeutic management is strongly recommended in selected patients with late complications.

Citing Articles

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Bile lakes in patients with biliary atresia who presented with jaundice-free native liver survival indicating the risk of subsequent liver transplantation due to various factors.

Gohda Y, Uchida H, Sumida W, Shirota C, Tainaka T, Makita S Pediatr Surg Int. 2024; 40(1):197.

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Percutaneous Transhepatic Biliary Intervention in Adult Biliary Atresia Patients After Kasai Portoenterostomy.

Onishi Y, Shimizu H, Ohno T, Furuta A, Isoda H, Okamoto T JPGN Rep. 2023; 3(2):e206.

PMID: 37168905 PMC: 10158411. DOI: 10.1097/PG9.0000000000000206.

Surgical and Medical Aspects of the Initial Treatment of Biliary Atresia: Position Paper.

Davenport M, Madadi-Sanjani O, Chardot C, Verkade H, Karpen S, Petersen C J Clin Med. 2022; 11(21).

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Primary exploring the value of metagenomic next-generation sequencing in detecting pathogenic bacteria of cholangitis with biliary atresia after Kasai operation.

Yu P, Li M, Sun R, Zhan J, Pan Y Pediatr Surg Int. 2022; 38(12):1931-1937.

PMID: 36269375 DOI: 10.1007/s00383-022-05254-4.

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