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Eur J Pediatr Surg 2020; 30(04): 364-370
DOI: 10.1055/s-0039-1692686
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Perioperative Complications after Kasai Hepatoportoenterostomy: Data from the Swiss National Biliary Atresia Registry

Ana M. Calinescu
1   Division of Pediatric Surgery, Hopitaux Universitaires de Geneve, University Center of Pediatric Surgery of Western Switzerland, Geneva, Switzerland
,
Jim C. H. Wilde
1   Division of Pediatric Surgery, Hopitaux Universitaires de Geneve, University Center of Pediatric Surgery of Western Switzerland, Geneva, Switzerland
,
Simona Korff
2   Unit of Pediatric Gastroenterology, Hepatology, and Nutrition, Hopitaux Universitaires de Geneve, Geneva, Switzerland
,
Valérie A. McLin
2   Unit of Pediatric Gastroenterology, Hepatology, and Nutrition, Hopitaux Universitaires de Geneve, Geneva, Switzerland
,
Barbara E. Wildhaber
1   Division of Pediatric Surgery, Hopitaux Universitaires de Geneve, University Center of Pediatric Surgery of Western Switzerland, Geneva, Switzerland
› Author Affiliations
Further Information

Publication History

11 January 2019

09 May 2019

Publication Date:
25 June 2019 (online)

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Abstract

Introduction Hepatoportoenterostomy (HPE) is the first-line treatment for biliary atresia (BA) patients. This study aims to describe perioperative complications after HPE and to analyze their impact on outcome.

Materials and Methods Patients with HPE (Swiss National Biliary Atresia Registry, 1994–2017) were retrospectively analyzed. Perioperative complications were defined as complications occurring up to 30 days after surgery. Surgical complications were defined as directly related to the surgical act; medical complications were defined as any other deviation from the uneventful postoperative course.

Results Sixty-two patients were included. Median age at HPE was 63 days (18–126). Twenty six patients out of 62 (42%) had ≥ 1 complications: 6/62 (10%) surgical, 24/62 (39%) medical, that is, we observed 7 surgical and 28 medical complications. As for medical complications, cholangitis was the most frequent: 19/28 (68%). Lower gestational age at birth correlated with more overall complications (p = 0.02). Age, weight at HPE, syndromic BA, and postoperative steroid administration were not significantly correlated. There were no perioperative deaths. Perioperative complications did not correlate with overall survival (p = 0.14) and survival with native liver (p = 0.55).

Conclusion HPE is often associated with perioperative medical complications. Lower gestational age at birth was significantly associated with more complications. Perioperative complications had no impact on overall outcome.

Keywords

hepatoportoenterostomy - biliary atresia - complications
 

  • References

  • 1 Wildhaber BE, Majno P, Mayr J. , et al. Biliary atresia: Swiss national study, 1994-2004. J Pediatr Gastroenterol Nutr 2008; 46 (03) 299-307
    CrossrefPubMedSearch in Google Scholar
  • 2 Davenport M, De Ville de Goyet J, Stringer MD. , et al. Seamless management of biliary atresia in England and Wales (1999-2002). Lancet 2004; 363 (9418): 1354-1357
    CrossrefPubMedSearch in Google Scholar
  • 3 Davenport M, Stringer MD, Tizzard SA, McClean P, Mieli-Vergani G, Hadzic N. Randomized, double-blind, placebo-controlled trial of corticosteroids after Kasai portoenterostomy for biliary atresia. Hepatology 2007; 46 (06) 1821-1827
    CrossrefPubMedSearch in Google Scholar
  • 4 Wilde JCH, Calinescu AM, Wildhaber BE. Perioperative complications in neonatal surgery: biliary atresia and choledochal malformations. Eur J Pediatr Surg 2018; 28 (02) 156-162
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Wildhaber BE. Biliary atresia: 50 years after the first kasai. ISRN Surg 2012; 2012: 132089
    PubMedSearch in Google Scholar
  • 6 Davenport M. Biliary atresia: clinical aspects. Semin Pediatr Surg 2012; 21 (03) 175-184
    CrossrefPubMedSearch in Google Scholar
  • 7 Davenport M, Ong E, Sharif K. , et al. Biliary atresia in England and Wales: results of centralization and new benchmark. J Pediatr Surg 2011; 46 (09) 1689-1694
    CrossrefPubMedSearch in Google Scholar
  • 8 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 2004; 240 (02) 205-213
    CrossrefPubMedSearch in Google Scholar
  • 9 Odiévre M, Valayer J, Razemon-Pinta M, Habib EC, Alagille D. Hepatic porto-enterostomy or cholecystostomy in the treatment of extrahepatic biliary atresia. A study of 49 cases. J Pediatr 1976; 88 (05) 774-779
    CrossrefPubMedSearch in Google Scholar
  • 10 Saeki M, Nakano M, Hagane K. [Early complications after hepatic porto-jejunostomy in biliary atresia]. Nippon Geka Gakkai Zasshi 1989; 90 (09) 1353-1356
    PubMedSearch in Google Scholar
  • 11 Madadi-Sanjani O, Carl N, Longerich T, Petersen C, Andruszkow JH. Inguinal hernias represent the most frequent surgical complication after kasai in biliary atresia Infants. BioMed Res Int 2015; 2015: 383791
    PubMedSearch in Google Scholar
  • 12 Townsend MR, Jaber A, Abi Nader H, Eid SM, Schwarz K. Factors associated with timing and adverse outcomes in patients with biliary atresia undergoing Kasai Hepatoportoenterostomy. J Pediatr 2018; 199: 237-242.e2
    CrossrefPubMedSearch in Google Scholar
  • 13 Stey AM, Kenney BD, Moss RL. , et al. A risk calculator predicting postoperative adverse events in neonates undergoing major abdominal or thoracic surgery. J Pediatr Surg 2015; 50 (06) 987-991
    CrossrefPubMedSearch in Google Scholar
  • 14 Kasai M, Suzuki H, Ohashi E, Ohi R, Chiba T, Okamoto A. Technique and results of operative management of biliary atresia. World J Surg 1978; 2 (05) 571-579
    CrossrefPubMedSearch in Google Scholar
  • 15 Moon SB, Park KW, Jae HJ, Jung SE. Caudate arterial branch bleeding: a rare complication after a Kasai portoenterostomy. J Pediatr Surg 2009; 44 (07) e27-e30
    PubMedSearch in Google Scholar
  • 16 Grisotti G, Cowles RA. Complications in pediatric hepatobiliary surgery. Semin Pediatr Surg 2016; 25 (06) 388-394
    CrossrefPubMedSearch in Google Scholar
  • 17 Cuffari C, Seidman E, DuBois J, Brochu P, Alvarez F. Acute intrahepatic portal vein thrombosis complicating cholangitis in biliary atresia. Eur J Pediatr 1997; 156 (03) 186-189
    CrossrefPubMedSearch in Google Scholar
  • 18 Escobar MA, Jay CL, Brooks RM. , et al. Effect of corticosteroid therapy on outcomes in biliary atresia after Kasai portoenterostomy. J Pediatr Surg 2006; 41 (01) 99-103
    CrossrefPubMedSearch in Google Scholar
  • 19 Kvist N, Davenport M. Thirty-four years' experience with biliary atresia in Denmark: a single center study. Eur J Pediatr Surg 2011; 21 (04) 224-228
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Eberhardt CS, Merlini L, McLin VA, Wildhaber BE. Cholestasis as the leading sign of a transmesenteric hernia in a split-liver transplanted child - a case report and review of literature. Pediatr Transplant 2012; 16 (05) E172-E176
    CrossrefPubMedSearch in Google Scholar
  • 21 Chen CC, Huang SC, Huang SC, Shieh CS. Retrograde intussusception as a complication of Roux-en-Y anastomosis for choledochal cyst--report of one case. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1994; 35 (06) 546-551
    PubMedSearch in Google Scholar
  • 22 Li M, Jin Q, Feng J. [Early postoperative complications of choledochal cyst excision and reconstruction of biliary tract]. Zhonghua Wai Ke Za Zhi 2001; 39 (09) 686-689
    PubMedSearch in Google Scholar
  • 23 Mullassery D, Pedersen A, Robb A, Smith N. Incisional hernia in pediatric surgery - experience at a single UK tertiary centre. J Pediatr Surg 2016; 51 (11) 1791-1794
    CrossrefPubMedSearch in Google Scholar
  • 24 Zani A, Davenport M. Inguinal hernias associated with biliary atresia. Eur J Pediatr Surg 2012; 22 (02) 117-120
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Joob B, Wiwanitkit V. Biliary atresia and inguinal hernia. Eur J Pediatr Surg 2012; 22 (06) 488
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Chung PH, Wong KK, Tam PK. Predictors for failure after Kasai operation. J Pediatr Surg 2015; 50 (02) 293-296
    CrossrefPubMedSearch in Google Scholar
  • 27 Houben C, Phelan S, Davenport M. Late-presenting cholangitis and Roux loop obstruction after Kasai portoenterostomy for biliary atresia. J Pediatr Surg 2006; 41 (06) 1159-1164
    CrossrefPubMedSearch in Google Scholar
  • 28 Oh M, Hobeldin M, Chen T, Thomas DW, Atkinson JB. The Kasai procedure in the treatment of biliary atresia. J Pediatr Surg 1995; 30 (07) 1077-1080
    CrossrefPubMedSearch in Google Scholar
  • 29 Ernest van Heurn LW, Saing H, Tam PK. Cholangitis after hepatic portoenterostomy for biliary atresia: a multivariate analysis of risk factors. J Pediatr 2003; 142 (05) 566-571
    CrossrefPubMedSearch in Google Scholar
  • 30 Luo Y, Zheng S. Current concept about postoperative cholangitis in biliary atresia. World J Pediatr 2008; 4 (01) 14-19
    CrossrefPubMedSearch in Google Scholar
  • 31 Chen Y, Nah SA, Chiang L, Krishnaswamy G, Low Y. Postoperative steroid therapy for biliary atresia: Systematic review and meta-analysis. J Pediatr Surg 2015; 50 (09) 1590-1594
    CrossrefPubMedSearch in Google Scholar
  • 32 Wada M, Nakamura H, Koga H. , et al. Experience of treating biliary atresia with three types of portoenterostomy at a single institution: extended, modified Kasai, and laparoscopic modified Kasai. Pediatr Surg Int 2014; 30 (09) 863-870
    CrossrefPubMedSearch in Google Scholar
  • 33 Nio M, Wada M, Sasaki H, Kazama T, Tanaka H, Kudo H. Technical standardization of Kasai portoenterostomy for biliary atresia. J Pediatr Surg 2016; 51 (12) 2105-2108
    CrossrefPubMedSearch in Google Scholar
  • 34 Zhang D, Yang HY, Jia J, Zhao G, Yue M, Wang JX. Postoperative steroids after Kasai portoenterostomy for biliary atresia: a meta-analysis. Int J Surg 2014; 12 (11) 1203-1209
    CrossrefPubMedSearch in Google Scholar
  • 35 Wu ET, Chen HL, Ni YH. , et al. Bacterial cholangitis in patients with biliary atresia: impact on short-term outcome. Pediatr Surg Int 2001; 17 (5-6): 390-395
    CrossrefPubMedSearch in Google Scholar
  • 36 Davenport M. Biliary atresia. Semin Pediatr Surg 2005; 14 (01) 42-48
    CrossrefPubMedSearch in Google Scholar
  • 37 Decharun K, Leys CM, West KW, Finnell SM. Prophylactic antibiotics for prevention of cholangitis in patients with biliary atresia status post-Kasai portoenterostomy: a systematic review. Clin Pediatr (Phila) 2016; 55 (01) 66-72
    CrossrefPubMedSearch in Google Scholar
  • 38 Superina R, Magee JC, Brandt ML. , et al; Childhood Liver Disease Research and Education Network. The anatomic pattern of biliary atresia identified at time of Kasai hepatoportoenterostomy and early postoperative clearance of jaundice are significant predictors of transplant-free survival. Ann Surg 2011; 254 (04) 577-585
    CrossrefPubMedSearch in Google Scholar
  • 39 Redkar R, Karkera PJ, Raj V, Bangar A, Hathiramani V, Krishnan J. Outcome of biliary atresia after Kasai's portoenterostomy: A 15-year experience. Indian Pediatr 2017; 54 (04) 291-294
    CrossrefPubMedSearch in Google Scholar
  • 40 Catré D, Lopes MF, Madrigal A. , et al. Predictors of major postoperative complications in neonatal surgery. Rev Col Bras Cir 2013; 40 (05) 363-369
    PubMedSearch in Google Scholar
  • 41 van Wessel DBE, Boere T, Hulzebos CV, de Kleine RHJ, Verkade HJ, Hulscher JBF. ; Also on behalf of the Netherlands Study group of Biliary Atresia, Registry (NeSBAR). Preterm infants with biliary atresia: A nationwide cohort analysis from The Netherlands. J Pediatr Gastroenterol Nutr 2017; 65 (04) 370-374
    CrossrefPubMedSearch in Google Scholar
  • 42 Chiu CY, Chen PH, Chan CF, Chang MH, Wu TC. ; Taiwan Infant Stool Color Card Study Group. Biliary atresia in preterm infants in Taiwan: a nationwide survey. J Pediatr 2013; 163 (01) 100-3.e1
    CrossrefPubMedSearch in Google Scholar
  • 43 Durkin N, Davenport M. Centralization of pediatric surgical procedures in the United Kingdom. Eur J Pediatr Surg 2017; 27 (05) 416-421
    Thieme ConnectPubMedSearch in Google Scholar
  • 44 Serinet MO, Wildhaber BE, Broué P. , et al. Impact of age at Kasai operation on its results in late childhood and adolescence: a rational basis for biliary atresia screening. Pediatrics 2009; 123 (05) 1280-1286
    CrossrefPubMedSearch in Google Scholar
  • 45 Hopkins PC, Yazigi N, Nylund CM. Incidence of biliary atresia and timing of Hepatoportoenterostomy in the United States. J Pediatr 2017; 187: 253-257
    CrossrefPubMedSearch in Google Scholar
  • 46 Tyraskis A, Parsons C, Davenport M. Glucocorticosteroids for infants with biliary atresia following Kasai portoenterostomy. Cochrane Database Syst Rev 2018; 5: CD008735
    PubMedSearch in Google Scholar
  • 47 Nio M, Wada M, Sasaki H, Tanaka H, Watanabe T. Long-term outcomes of biliary atresia with splenic malformation. J Pediatr Surg 2015; 50 (12) 2124-2127
    CrossrefPubMedSearch in Google Scholar
  • 48 Davenport M, Savage M, Mowat AP, Howard ER. Biliary atresia splenic malformation syndrome: an etiologic and prognostic subgroup. Surgery 1993; 113 (06) 662-668
    PubMedSearch in Google Scholar
  • 49 Bezerra JA, Spino C, Magee JC. , et al; childhood liver disease research and education network (ChiLDREN). Use of corticosteroids after hepatoportoenterostomy for bile drainage in infants with biliary atresia: the START randomized clinical trial. JAMA 2014; 311 (17) 1750-1759
    CrossrefPubMedSearch in Google Scholar
  • 50 Qiu JL, Shao MY, Xie WF. , et al. Effect of combined ursodeoxycholic acid and glucocorticoid on the outcome of Kasai procedure: a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97 (35) e12005
    PubMedSearch in Google Scholar
  • 51 Lally KP, Kanegaye J, Matsumura M, Rosenthal P, Sinatra F, Atkinson JB. Perioperative factors affecting the outcome following repair of biliary atresia. Pediatrics 1989; 83 (05) 723-726
    PubMedSearch in Google Scholar
  • 52 Karrer FM, Lilly JR, Stewart BA, Hall RJ. Biliary atresia registry, 1976 to 1989. J Pediatr Surg 1990; 25 (10) 1076-1080
    CrossrefPubMedSearch in Google Scholar