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Original ArticleOpen Access
Peri-Operative Factors Predicting the Outcome of Hepatic Porto-Enterostomy in Infants with Biliary Atresia
Sangkhathat S 
,
Patrapinyokul S ,
Tadtayathikom K ,
Osatakul MS
,
Patrapinyokul S ,
Tadtayathikom K ,
Osatakul MS SAKDA PATRAPINYOKUL,MD*,
SEKSIT OSA T AKUL, MD**
Introduction
: Without hepatic transplantation, hepatic porto-enterostomy is the only defini-
tive surgical therapy for infants with biliary atresia. Unfortunately, clearance of jaundice by the pro-
cedure is not promising. Pre-operative data that may predict the outcome is of great value in the
selection of surgical candidates. Early post-operative determinants of outcome also help in follow-up
planning.
Objective
: To determine peri-operative factors influencing jaundice clearance after hepatic
porto-enterostomy in infants with biliary atresia
Patients and Method
: Clinical and laboratory data of pediatric patients undergoing hepatic
porto-enterostomy in Songklanagarind Hospital from 1988 to 2001 were reviewed regarding age at
operation, clinical presentation, gross pathology of bile duct atresia, liver function profiles and changes
after the procedure, liver pathology and post-operative ascending cholangitis. Univariate comparison
followed by multivariate logistic regression analysis was analyzed against the clearance of jaundice.
Statistical analysis was aided by the Stata 7.0 program. Statistical significance was set at p-value less
than 0.05.
Results
: There were 62 infants operated on during the thirteen-year period. Four cases of
operative death and a case lost to follow-up before the second post-operative month was excluded. The
median age at the operation was 78 days (34-326 days). Twenty-four cases (42.1%) presented with
signs of portal hypertension. After the operation, 19 cases (33.4%) were jaundice free, 6 cases ( 10.5%)
had fair clearance and 32 cases (56.1%) had a poor result. Univariate analysis revealed an association
between age at surgery and jaundice clearance. Post-operative stool color and decline of total bilirubin
level at one month after surgery were significantly correlated with the outcome (p
<
O.Ol). Cholangitis
within the first post-operative month significantly had an adverse effect on the short-term survival
probability. Multivariate analysis showed an independent association of jaundice clearance with age
at surgery and type of bile duct atresia.
Vol. 86 No.3
OUTCOME OF KASAl'S OPERATION FOR BILIARY ATRESIA
225
Conclusion : Age of the infants younger than 60 days and type I of bile duct atresia were
the key determinants of successful hepatic porto-enterostomy. Early cholangitis was an accelerator of
progressive cirrhosis. Stool color and bilirubin level at one month after surgery can
be
used as pre-
dictors of jaundice clearance.
Key word : Biliary Atresia, Hepatic Porto-Enterostomy, Kasai's Operation, Ascending Cholangitis
SEKSIT OSA T AKUL, MD**
Introduction
: Without hepatic transplantation, hepatic porto-enterostomy is the only defini-
tive surgical therapy for infants with biliary atresia. Unfortunately, clearance of jaundice by the pro-
cedure is not promising. Pre-operative data that may predict the outcome is of great value in the
selection of surgical candidates. Early post-operative determinants of outcome also help in follow-up
planning.
Objective
: To determine peri-operative factors influencing jaundice clearance after hepatic
porto-enterostomy in infants with biliary atresia
Patients and Method
: Clinical and laboratory data of pediatric patients undergoing hepatic
porto-enterostomy in Songklanagarind Hospital from 1988 to 2001 were reviewed regarding age at
operation, clinical presentation, gross pathology of bile duct atresia, liver function profiles and changes
after the procedure, liver pathology and post-operative ascending cholangitis. Univariate comparison
followed by multivariate logistic regression analysis was analyzed against the clearance of jaundice.
Statistical analysis was aided by the Stata 7.0 program. Statistical significance was set at p-value less
than 0.05.
Results
: There were 62 infants operated on during the thirteen-year period. Four cases of
operative death and a case lost to follow-up before the second post-operative month was excluded. The
median age at the operation was 78 days (34-326 days). Twenty-four cases (42.1%) presented with
signs of portal hypertension. After the operation, 19 cases (33.4%) were jaundice free, 6 cases ( 10.5%)
had fair clearance and 32 cases (56.1%) had a poor result. Univariate analysis revealed an association
between age at surgery and jaundice clearance. Post-operative stool color and decline of total bilirubin
level at one month after surgery were significantly correlated with the outcome (p
<
O.Ol). Cholangitis
within the first post-operative month significantly had an adverse effect on the short-term survival
probability. Multivariate analysis showed an independent association of jaundice clearance with age
at surgery and type of bile duct atresia.
Vol. 86 No.3
OUTCOME OF KASAl'S OPERATION FOR BILIARY ATRESIA
225
Conclusion : Age of the infants younger than 60 days and type I of bile duct atresia were
the key determinants of successful hepatic porto-enterostomy. Early cholangitis was an accelerator of
progressive cirrhosis. Stool color and bilirubin level at one month after surgery can
be
used as pre-
dictors of jaundice clearance.
Key word : Biliary Atresia, Hepatic Porto-Enterostomy, Kasai's Operation, Ascending Cholangitis
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