Extended Adhesion-Sparing Liver Eversion during Kasai Portoenterostomy for Infants with Biliary Atresia.

Filippo Parolini,Maurizio Cheli,Michele Colledan,Giovanni Boroni,Domenico Pinelli,Pietro Betalli,Daniele Alberti

doi:10.3390/children8090820

Filippo Parolini, Maurizio Cheli + Show 5 more

Open Access

https://doi.org/10.3390/children8090820

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Abstract

Background: Despite the fact that Kasai portoenterostomy (KPE) is the primary treatment for biliary atresia (BA), liver transplantation (LT) remains the ultimate surgery for two-thirds of these patients. Their true survival rate with the native liver reflects the original KPE and the burden of post-operative complications. We report an original modification of the adhesion-sparing liver eversion (ASLE) technique during KPE that facilitates the total native hepatectomy at time of transplantation. Methods: All consecutive patients with BA who underwent KPE at our department and subsequent LT at Paediatric Liver Transplant Centre at Papa Giovanni XXIII Hospital between 2010–2018 were retrospectively enrolled. All patients underwent ASLE during KPE. Patients’ demographic data, type of KPE, total transplant time (TTT), hepatectomy time (HT), intra-operative packed red blood cells and plasma transfusions, intra- and post-operative complications were noted. Results: 44 patients were enrolled. Median TTT and HT were 337 and 57 min, respectively. The median volume of packed red blood cell transfusion was 95 mL. No patients presented bowel perforation during the procedure or in the short post-operative course. No mortality after LT was recorded. Conclusions: In addition to the well-known advantages of the standard liver eversion technique, ASLE reduces the formation of intra-abdominal adhesions, lowering significantly the risk of bowel perforation and bleeding when liver transplantation is performed for failure of KPE.

Highlights

The Kasai portoenterostomy (KPE) has dramatically improved the outcomes in children affected by biliary atresia (BA), most of them eventually require liver transplantation (LT), even after an initially successful KPE [7,8,9,10,11]
The original KPE consists of resecting the atretic gallbladder and the extrahepatic biliary tree, leaving a denuded porta hepatis, which is reconstructed into a 40 cm jejunal Roux loop [2,4,6]
Sectioning the right triangular and coronary ligaments requires a generous widening of the laparotomy, which facilitates the breakthrough of the small bowel from the abdominal cavity, increasing the occurrence of post-operative adhesions

Summary

Introduction

In 1959, Kasai reported an operative procedure consisting of a hepatic portoenterostomy (KPE) in which the atretic extrahepatic tissue was removed, and a Roux-en-Y jejunal loop was anastomosed to the hepatic hilum in order to restore bile drainage [3] Nowadays, this operation with current modifications is widely accepted and has become established as the primary treatment for BA [3,4], resulting in successful bile drainage in more than half of patients [1,4]. Despite the fact that Kasai portoenterostomy (KPE) is the primary treatment for biliary atresia (BA), liver transplantation (LT) remains the ultimate surgery for two-thirds of these patients Their true survival rate with the native liver reflects the original KPE and the burden of postoperative complications. We report an original modification of the adhesion-sparing liver eversion (ASLE) technique during KPE that facilitates the total native hepatectomy at time of transplantation

Methods

Results

Conclusion