Clinical efficacy of modified portoenterostomy for biliary atresia

Abstract

Objective To explore the clinical efficacy of modified portoenterostomy (PE) for biliary atresia (BA). Methods The BA (type Ⅲ) patients undergoing PE from March 2012 to February 2014 are retrospectively analyzed. Based upon the types of PE, they were divided into three groups of extended portoenterostomy (EPE), Nakamura's modified Kasai portoenterostomy (MKPE) and modified Kasai portoenterostomy (OMKPE) respectively. Their demographic characteristics, rate of jaundice free (JF), incidence of cholangitis (CO) and survival rate of native liver (SNL) were compared. And the same profiles were compared according to operative duration (≤90 d and >90 d). Results A total of 87 cases obtained a complete follow-up and the cases of EPE, MKPE, OMKPE were 34, 19 and 34 respectively. No significant difference existed in age, weight and preoperative indices of liver function. Ohi subtype of extrahepatic bile duct and Weerasooriya's grade of liver fibrosis showed no inter-group differences (P>0.05). JF and SNL were higher in OMKPE than those in EPE (73.5%, 73.5% vs. 38.2%, 38.2%, P 0.05). In group of operative duration ≤90 d, JF and SNL were higher in OMKPE (90.9%, 90.9%) and MKPE (90%, 90%) than EPE (46.2%, 38.5%) (P 0.05). In group of operative duration >90 d, the highest JF ratio and SNL were found in OMKPE (65.2%, 65.2%) (P 0.05). Conclusions Compared with EPE and MKPE, OMKPE is more efficient in clearing jaundice and boosting survival rate of native liver, especially for cases with operative duration >90 d. Key words: Biliary atresia; Anastomosis; Survival rate