| ORIGINAL ARTICLE
|Year : 2019 | Volume
| Issue : 4 | Page : 271-274
Age is not a criterion in patient selection for kasai portoenterostomy
Priya Ramachandran1, Mohamed Safwan2, Vidya Tamizhvanan3, Muthukrishnan Saravana Balaji3, Ashitha K Unny3, Mukul Vij2, Mohamed Rela2
1 Department of Pediatric Surgery, Kanchi Kamakoti CHILDS Trust Hospital, CHILDS Trust Medical Research Foundation; Department of Surgery and Pathology, Gleneagles Global Healthy City and Dr. Rela Institute and Medical Center Bharat Institute of Higher Education and Research, Chennai, Tamil Nadu, India
2 Department of Surgery and Pathology, Gleneagles Global Healthy City and Dr. Rela Institute and Medical Center, Bharat Institute of Higher Education and Research, Chennai, Tamil Nadu, India
3 Department of Pediatric Surgery, Kanchi Kamakoti CHILDS Trust Hospital, CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India
Aims: The aim of our study was to compare the outcome of Kasai portoenterostomy (KPE) in children with biliary atresia (BA) older than 90 days to children less than 90 days and to study its safety and efficacy in children older than 90 days.
Subjects and Methods: Relevant data were collected from our prospectively maintained database of all children with BA who underwent KPE over a 5-year period. Children were divided into two groups: Group 1 ≤90 days and Group 2 >90 days. Data analyzed and compared included total and direct bilirubin, aspartate aminotransferase-to-platelet ratio index (APRI), and the outcome of procedure which was defined as a serum direct bilirubin <2 mg/dl within 6 months after surgery. Standard statistical tests were used for analysis.
Results: Out of 62 children, 45 children were in Group 1 and 17 children were in Group 2. Children in Group 2 had similar total and direct bilirubin compared to children in Group 1. APRI, an indicator of fibrosis, was significantly increased in Group 2 (P = 0.08). About 47% of children in Group 2 had Stage III fibrosis on liver histology compared to 22% of children in Group 1. None of the children in Group 2 had synthetic liver failure (refractory ascites, hypoalbuminemia, or coagulopathy unresponsive to Vitamin K) or portal hypertension. KPE was successful in 29.4% of children in Group 2 and 44% in children in Group 1. There was no perioperative mortality in our group.
Conclusions: KPE was successful in a third of children over 90 days of age and can be safely performed in this group. In the absence of synthetic liver failure, age should not be a disqualification for performing KPE.
Dr. Priya Ramachandran
No. 10, Nageswara Road, Nungambakkam, Chennai - 600 038, Tamil Nadu
Source of Support: None, Conflict of Interest: None
[FULL TEXT] [PDF]*