Abstract
BackgroundKasai procedure is the standard initial treatment of infants with biliary atresia. The key to perform a successful surgery is to accurately remove the fibrous portal plate near the liver hilum. Yet how to estimate surgical difficulty pre-operatively remains unclear. This study aims to design an algorithm that predicts the difficulty of Kasai procedure using liver stiffness measurement (LSM).MethodsOne hundred ninety-nine patients were included from April 2012 to December 2016. The patients were all surgically diagnosed with biliary atresia. Group A comprised of patients with porta hepatis retraction (the angle between the plane of the fibrous porta plate and the plane of the medial liver closest to the plate was equal to or smaller than 90°), group B comprised of patients without porta hepatis retraction (the angle between the plane of the fibrous porta plate and the plane of the medial liver closest to the plate was greater than 90°). Liver function measurements and LSM were measured for all patients within three days before surgery.ResultsOur study included 19 cases in group A (9 males, 10 females) and 180 cases in group B (87 males, 93 females). LSM had statistical differences between the two groups, 28.10(14.90) kPa VS 10.89(7.10) kPa, P = 0.000. There was a significant relationship between LSM and operative age, TBA, AST, GGT (P = 0.000, 0.003, 0.003, 0.012, correlation coefficient = 0.323, 0.213, 0.207, 0.179). The AUROC of LSM was 0.919. When the cutoff value was 15.15 kPa(OR = 3.989; P = 0.000), the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 0.947, 0.750, 0.285, 0.992 and 0.768, respectively. When the value was 23.75 kPa(OR = 3.483; P = 0.000), the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 0.631, 0.950, 0.571, 0.960 and 0.919, respectively.ConclusionsLSM can be used to predict the difficulty in dissecting fibrous portal plate, and in turn, the difficulty of Kasai procedure. LSM > 23.75 kPa suggests a more complicated surgery.
Highlights
Kasai procedure is the standard initial treatment of infants with biliary atresia
From the 199 cases, there was no relationship between liver stiffness measurement (LSM) and alkaline phosphatase (ALP) (P = 0.177), LSM and Alanine aminotransferase (ALT) (P = 0.058), LSM and total bilirubin (TBIL) (P = 0.188), or LSM and direct bilirubin (DBIL) (P = 0.173)
There was a significant relationship between LSM and operative age (P = 0.000, correlation coefficient = 0.323), LSM and Aspartate aminotransferase (AST) (P = 0.003, correlation coefficient = 0.207), LSM and R-glutamyl transferase (GGT) (P = 0.012, correlation coefficient = 0.179), LSM and total bile acid (TBA)
Summary
Kasai procedure is the standard initial treatment of infants with biliary atresia. This study aims to design an algorithm that predicts the difficulty of Kasai procedure using liver stiffness measurement (LSM). The Kasai procedure, introduced by Kasai from Japan, is the standard initial operation for treatment of infants with BA. The adequate level of transection of the fibrous portal plate near the hilum of the liver is one of the most important steps, which is the most difficult part of the operation. Surgical observation of our center shows that the porta hepatis retraction may affect the transection level owing to exposure difficulty. The purpose of this study is to evaluate the porta hepatis retraction by preoperative non-invasive LSM examination, to assist in predicting the difficulty of the Kasai procedure
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