Peri-Operative Factors Predicting the Outcome of Hepatic Porto-Enterostomy in Infants with Biliary Atresia
SURASAK SANGKHATHAT, MD*, SAKDA PATRAPINYOKUL,MD*, KAMOLNATE TADTA YATHIKOM, MD*, SEKSIT OSA TA KUL, MD**
Affiliation : * Pediatric Surgery Unit, Department of Surgery, ** Department of Pediatrics. Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
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.
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.
Keywords : Biliary Atresia, Hepatic Porto-Enterostomy, Kasai's Operation, Ascending Cholangitis
