Clinical and Laboratory ObservationsCholangitis after hepatic portoenterostomy for biliary atresia: A multivariate analysis of risk factors☆
Section snippets
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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Cited by (82)
Characteristics of infections and their risk factors in children with biliary atresia
2023, Clinics and Research in Hepatology and GastroenterologyPeri-Kasai portoenterostomy sutures anchoring the jejunal loop to Glisson capsule: A novel modification to reduce the incidence of cholangitis: peri-Kasai portoenterostomy anchor of jejunal loop
2023, Asian Journal of SurgeryCitation Excerpt :The occurrence of cholangitis is multifactorial with the main causes being small bile ductules, slow bile flow, ascending infection from the jejunal limb (bacterial translocation and/or colonization), reduction of lymph drainage at the porta hepatis, dehydration, scarring due to the natural process of healing, and stenosis of portoenterostomy anastomosis. These factors act in a vicious circle that ends in the development of liver failure and initiation of LT programs for these patients.12,13 Considering the presence and similarity of all leading causes of cholangitis in both study groups, our modification contributed to a significant reduction in the rate of cholangitis in Group B. Thus, infants who experienced fewer attacks of cholangitis would be expected to have longer survival with their native livers.
Long-term outcomes of biliary atresia patients surviving with their native livers
2022, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :Development of hepatic bile lakes promotes biliary stasis and is another important risk factor for recurrent cholangitis after PE [38]. Cholangitis frequency is highest during the first months and years after PE, and patients experiencing cholangitis during this time period are also at highest risk for recurrent episodes [31,35]. Although the risk of cholangitis is greater if COJ is not achieved [31], about two thirds of NL survivors have had at least one cholangitis episode by the age of 10 and one third of them still experience cholangitis in the adult age [34,39,40].
Complications and Quality of Life in Long-Term Survivors of Biliary Atresia with Their Native Livers
2022, Journal of PediatricsAssessment of Lactobacillus casei rhamnosus (LGG) therapy in children with biliary atresia – Randomized placebo controlled trial
2021, Clinics and Research in Hepatology and GastroenterologyDeletion of interleukin enhancer binding factor 2 (ILF2) resulted in defective biliary development and bile flow blockage
2021, Journal of Pediatric Surgery
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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].