The Relationship between Clinical Outcomes After Kasai Operation and Related Factors in Infants with Biliary Atresia
Mongkol Laohapensang MD, FRCST*, Patcharaphan Srikuancharoen MD**
Affiliation : * Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Surgery, Chaophraya Yommaraj Hospital, Suphanburi, Thailand
Background : Biliary atresia (BA) has unclear etiology, leading to cholestasis and cirrhosis. Kasai portoenterostomy has
been accepted worldwide as the primary treatment for establishing biliary drainage. Successful Kasai operation increases the
survival and reduces the incidence of subsequent liver transplantation. Several prognostic factors have been related to the
results of this procedure.
Objective : To study the relationship between clinical outcomes after Kasai operation and related factors in infants with BA.
Design of study: Retrospective charts review.
Material and Method: The medical data of 48 infants with BA who underwent Kasai operation in the Division of Pediatric
Surgery at Siriraj hospital (from January 1st, 2006 to May 31st, 2015) were retrospectively reviewed. Ten patients were
excluded due to incomplete clinical data. Finally, 38 patients were enrolled in this study. The variables including clinical,
laboratory database, radiologic findings, operative findings, and post-operative conditions were chosen for study.
Results : The median onset of visible jaundice was 4 (0 to 16) weeks of age. The median age at Kasai operation was 82 (34 to
204) days. There were 25 (65.8%) cases who could achieve post-operative jaundice clearance. The incidence of post-
operative cholangitis was 30 (78.9%) cases. The age at the time of Kasai operation had a significant impact on post-operative
jaundice clearance in patients with (p-value = 0.028). The cut-off age, defined by the ROC curve analysis, was 90 days (p-
value = 0.042). Odds ratio for age at the operation of less than or equal to jaundice clearance in patients with 90 days was
4.78 (95% CI 1.13 to 21.32).
Conclusion : The age at the time of Kasai operation has a significant impact jaundice clearance in patients with on the ability
to achieve post-operative jaundice clearance. The patients whose ages at the operation of more than 90 days have a significant
risk for delay clearance of jaundice compared to those of ages less than or equal to 90 days.
Keywords : Biliary atresia, Kasai operation, Portoenterostomy, Age, Outcome
