Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Apr-Jun;21(2):66-71.
doi: 10.4103/0971-9261.176941.

The extended Kasai portoenterostomy for biliary atresia: A preliminary report

Priya Ramachandran  1 , Mohamed Safwan  2 , Sankaranarayanan Srinivas  3 , Naresh Shanmugam  4 , Mukul Vij  2 , Mohamed Rela  4
Affiliations

The extended Kasai portoenterostomy for biliary atresia: A preliminary report

Priya Ramachandran et al. J Indian Assoc Pediatr Surg. 2016 Apr-Jun.

Abstract

Aims: In 1955, Professor Morio Kasai first performed a hepatic portoenterostomy. Since then, the procedure has changed the lives of children with biliary atresia (BA). We report our initial experience in performing "extended" Kasai portoenterostomy (KPE), a modification of the original procedure.

Materials and methods: Since 2013, we have used the technique of "extended KPE" and prospectively recorded data on all children undergoing this operation. Data on demographics, clinical features, liver function tests, and perioperative cholangiogram findings were collected. Outcome of KPE was measured by Jaundice Disappearance Rate (JDR) and Native Liver Survival Rate (NLSR). We present our preliminary results from a 30-month period (February 2013 to May 2015).

Results: Thirty-one children underwent KPE during this period (19 males) and only 1 child had biliary atresia splenic malformation (BASM). The mean age at KPE was 73 ± 24 days. Five (16.1%) children were more than 90 days old at the time of KPE. Fourteen children cleared jaundice (JDR 45.2%). Eleven (35.5%) children developed episodes of cholangitis, of whom 8 had early cholangitis (within 3 months of the operation). The proportion of children who survived with their own liver 6 months after KPE (NLSR) was 84.2%. Of those children older than 90 days, 2 cleared jaundice and have survived with their native livers for more than 16 months.

Conclusion: In our preliminary report of 31 children, we conclude that the extended KPE leads to increased jaundice clearance and improved NLSR in children with BA.

Keywords: Biliary atresia (BA); Kasai portoenterostomy (KPE); jaundice clearance; native liver survival.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Liver hilum in a child with BA after excision of the fibrotic portal plate
Figure 2
Figure 2
Illustration showing the distribution of the ductules at the porta hepatis
See this image and copyright information in PMC

References

    1. Garcia AV, Cowles RA, Kato T, Hardy MA. Morio Kasai: A remarkable impact beyond the Kasai procedure. J Pediatr Surg. 2012;47:1023–7. - PMC - PubMed
    1. Kasai M, Suzuki S. A new operation for non-correctable biliary atresia-hepatic portoenterostomy. Shijitsu. 1959;13:733–9.
    1. Hadzic N, Davenport M, Tizzard S, Singer J, Howard ER, Mieli-Vergani G. Long-term survival following Kasai portoenterostomy: Is chronic liver disease inevitable? J Pediatr Gastroenterol Nutr. 2003;37:430–3. - PubMed
    1. Davenport M, Ong E, Sharif K, Alizai N, McClean P, Hadzic N, et al. Biliary atresia in England and Wales: Results of centralization and new benchmark. J Pediatr Surg. 2011;46:1689–94. - PubMed
    1. Hashimoto T, Otobe Y, Shimizu Y, Suzuki T, Nakamura T, Hayashi S, et al. A modification of hepatic portoenterostomy (Kasai operation) for biliary atresia. J Am Coll Surg. 1997;185:548–53. - PubMed