Clinical and Laboratory Observations
Cholangitis after hepatic portoenterostomy for biliary atresia: A multivariate analysis of risk factors

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Abstract

Cholangitis occurred in 59% of 77 patients who underwent the portoenterostomy procedure for biliary atresia between 1980 and 2000. Good postoperative bile drainage was associated with a lower risk of cholangitis than partial (odds ratio, 5.72; 95% CI, 2.89–11.3) or poor (odds ratio, 3.29; 95% CI, 1.89–5.7) bile drainage. Cholangitis was not an independent risk factor for death or liver transplantation. (J Pediatr 2003;142:566-71 )

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Study Design

Consecutive patients (n = 77) who underwent portoenterostomy for biliary atresia at Queen Mary Hospital, Hong Kong, between January 1980 and January 2000 were studied retrospectively. Patients whose initial operations were performed elsewhere and who were referred later to our hospital were excluded from analysis. All patients underwent the operation as originally described by Kasai and Suzuki5 with an unmodified 40-cm Roux-en-Y jejunal conduit. External venting was not performed, nor were

Results

Seventy-seven patients (36 male, 41 female) with a median age of 68 days (range, 32–153 days) underwent a Kasai I procedure for extrahepatic biliary atresia.4 There were no operative deaths. Forty-five of 76 patients at risk (59%, 95% CI, 47–70) had at least one episode of cholangitis, with a total of 168 episodes, which were characterized by fever in 98%, deepening jaundice in 57%, and elevated or lowered WBC counts in 61%. Blood cultures were positive in 23% of the episodes. Thirty-seven

Discussion

Cholangitis is a frequent and serious complication after hepatic portoenterostomy for biliary atresia. It has an estimated incidence between 40% and 93% of patients and usually develops in the first year after operation.8, 9, 10, 11 The great discrepancy in the reported incidences may be caused by the use of different criteria for the diagnosis of cholangitis and the general lack of definitions. Cholangitis is usually characterized by fever with or without jaundice if other causes of infection

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Reprint requests: Pr Paul K. H. Tam, Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China. E-mail: [email protected].

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