Modification of the Kasai portoenterostomy in biliary atresia and its impact on treatment outcomes
DOI:
https://doi.org/10.15574/PP.2026.1(105).7479Keywords:
biliary atresia, modified portoenterostomy, classical portoenterostomy, bile duct microstructures, postoperative cholangitis, native liver survivalAbstract
Biliary atresia (BA) is a severe progressive cholangiopathy of infancy that, without timely surgical treatment, leads to end-stage liver failure. Despite the widespread use of the Kasai portoenterostomy, postoperative cholangitis and other related complications remain the major causes of native liver loss.
Aim - to evaluate the impact of modified portoenterostomy (MPE) on surgical outcomes in patients with BA and to determine its clinical advantages with classical Kasai portoenterostomy (CPE).
Materials and methods. A retrospective non-randomized single-center study was conducted involving 63 patients with BA who underwent surgery at less than 60 days of age. CPE was performed in 24 patients and MPE in 39. Preoperative assessment included clinical and laboratory evaluation, ultrasound examination, liver biopsy, and intraoperative cholangiography. The incidence of postoperative cholangitis and bile leakage, duration of drainage, rate of bilirubin normalization, and native liver survival were assessed.
Results. The incidence of postoperative cholangitis was significantly lower in the MPE group than in the CPE group (1.3±0.6 vs. 2.1±0.8 episodes per patient). Bile leakage occurred less frequently after MPE (7.7% vs. 25.0%). Drainage duration was shorter in the MPE group (6.8±1.9 vs. 9.2±2.1 days). There was also a trend toward faster bilirubin normalization (54±9 vs. 62±10 days) and higher native liver survival (61.5% vs. 45.8%).
Conclusions. Modified portoenterostomy reduced the incidence of postoperative cholangitis and bile leakage, shortened drainage duration, and demonstrated a tendency toward improved long-term outcomes in patients with biliary atresia.
The research was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the specified institution. The informed consent of the patients was obtained from the patients’ parents.
The author declares no conflict of interest.
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