Surgical modifications of the Kasai hepatoportoenterostomy minimize invasiveness without compromising short- and medium-term outcomes

Christine J Park; Sarah J Armenia; Connie H Keung; Jocelyn T Compton; Robert A Cowles

doi:10.1016/j.jpedsurg.2018.06.028

Surgical modifications of the Kasai hepatoportoenterostomy minimize invasiveness without compromising short- and medium-term outcomes

J Pediatr Surg. 2019 Mar;54(3):537-542. doi: 10.1016/j.jpedsurg.2018.06.028. Epub 2018 Jul 6.

Authors

Christine J Park¹, Sarah J Armenia², Connie H Keung³, Jocelyn T Compton⁴, Robert A Cowles⁵

Affiliations

¹ Department of Surgery, Section of Pediatric Surgery at Yale University, 330 Cedar St, FMB 131, New Haven, CT 06510, USA. Electronic address: christine.park@yale.edu.
² Department of Surgery, Section of Pediatric Surgery at Yale University, 330 Cedar St, FMB 131, New Haven, CT 06510, USA. Electronic address: sarah.armenia@yale.edu.
³ Department of Surgery, Division of Pediatric Surgery at Columbia University College of Physicians and Surgeons, 3959 Broadway, CHN 216B, New York, NY 10032, USA. Electronic address: ckeung@iupui.edu.
⁴ Department of Surgery, Division of Pediatric Surgery at Columbia University College of Physicians and Surgeons, 3959 Broadway, CHN 216B, New York, NY 10032, USA. Electronic address: jocelyn.traina@gmail.com.
⁵ Department of Surgery, Section of Pediatric Surgery at Yale University, 330 Cedar St, FMB 131, New Haven, CT 06510, USA; Department of Surgery, Division of Pediatric Surgery at Columbia University College of Physicians and Surgeons, 3959 Broadway, CHN 216B, New York, NY 10032, USA. Electronic address: robert.cowles@yale.edu.

PMID: 30041859
DOI: 10.1016/j.jpedsurg.2018.06.028

Abstract

Background: Biliary atresia (BA) causes progressive fibrosis and obliteration of the biliary tree, resulting in bile stasis and eventual liver dysfunction. It affects 1 in 10,000-18,000 infants, and if left untreated, universally leads to liver failure. The Kasai hepatoportoenterostomy (KPE) was developed as an effective surgical therapy for BA and can restore bile drainage into the intestine. Traditionally, the KPE procedure extra-corporealizes the liver to expose the portal plate. Here, we describe modifications to the procedure via a smaller incision in which the liver remains within the abdominal cavity and we compare the outcomes of this technique to previous institutional outcomes and to contemporary international series.

Materials and methods: We identified all patients who underwent KPE for BA at a single institution between 1994 and 2012. Patient outcomes after the modified KPE performed from 2004 to 2012 were compared to data from infants who underwent the traditional KPE from 1994 to 2003.

Results: Ninety-nine patients were identified. Fifty-two were in the traditional KPE group and 47 in the modified KPE group. There was no difference in mean age at surgery. Median follow-up was 64 months (traditional KPE) and 46 months (modified KPE). The rate of native liver survival (39.1% vs 48.5%), overall survival (89.2% vs 97.8%), liver transplant occurring under one year of age (36.5% vs 40.4%) and median time to liver transplant (188 vs 172 days) were not statistically different between groups (p > 0.05 for all comparisons). The results of the modified KPE compared favorably to published outcomes.

Conclusion: The described modifications to the KPE appear to yield equivalent outcomes when compared to the traditional KPE procedure and compare well with published outcomes in the literature. It is possible that the procedure described here results in less scarring and technically easier liver transplant procedures.

Level of evidence: Level III.

Keywords: Biliary atresia; Hepatoportoenterostomy; Kasai procedure; Minimally invasive surgery.

Publication types

Comparative Study

MeSH terms

Biliary Atresia / mortality
Biliary Atresia / surgery*
Female
Humans
Infant
Infant, Newborn
Intestines / surgery
Liver / pathology
Liver / surgery
Liver Transplantation / statistics & numerical data
Male
Portoenterostomy, Hepatic / methods*
Retrospective Studies
Survival Analysis