Current management of long-term survivors of biliary atresia: over 40 years of experience in a single center and review of the literature

Hideyuki Sasaki, Hiromu Tanaka, Masaki Nio

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

Introduction: Owing to several therapeutic advancements, more patients with biliary atresia now survive into adulthood while retaining their native liver. However, the optimal strategy for long-term management of such patients remains unclear. Methods: Aiming to establish the current management strategies, we reviewed previous reports of long-term outcome of BA who underwent surgery at our institution as well as the relevant literature, focusing particularly on the treatment of late complications. Results: Approximately 30–40% of long-term survivors of biliary atresia who retain their native liver exhibit late sequelae such as cholangitis and portal hypertension. Early and appropriate intervention with Kasai portoenterostomy is essential for ensuring long-term survival with good quality of life. In our hospital, the current standard for Kasai portoenterostomy involves dissecting the fibrous remnants along the porta hepatis, just on the level of the liver capsule. Cholangitis is an important late complication in biliary atresia, and the possibility of mechanical obstruction of the biliary drainage route or deformity of the intrahepatic bile ducts with or without gallstones should be thoroughly evaluated in patients with intractable cholangitis. Regarding portal hypertension, appropriate interventions such as endoscopic variceal treatment and partial splenic embolization are considered to provide good quality of life when hepatic function is preserved. Conclusion: Appropriate therapeutic management is strongly recommended in selected patients with late complications.

Original languageEnglish
Pages (from-to)1327-1333
Number of pages7
JournalPediatric Surgery International
Volume33
Issue number12
DOIs
Publication statusPublished - 2017 Dec 1

Keywords

  • Biliary atresia
  • Kasai portoenterostomy
  • Late sequela
  • Long-term outcome
  • Native liver survival
  • Surgical technique

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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