Comparison of drainage techniques for biliary atresia.
OBJECTIVE
Traditional Kasai portoenterostomy and porto-appendiceal duodenostomy have been utilized for biliary atresia. Differences in outcome between patients who underwent either Kasai portoenterostomy or porto-appendiceal duodenostomy were compared.


METHODS
A review of all children who underwent a drainage procedure for biliary atresia from 1986 to 2000 (n = 30) was performed. Age at drainage procedure, subsequent liver transplantation, and outcomes were evaluated. Outcome variables included success rates (total bilirubin < 2.0 mg/dL) and survival rate. Statistical analysis was done with chi2 and Student's t test.


RESULTS
Long-term follow-up was available on 28 of 30 patients. Age at biliary drainage was insignificant. Success rates between porto-appendiceal duodenostomy (31%) and Kasai portoenterostomy (82%) were statistically significant. Survival rate for patients who underwent a Kasai portoenterostomy was 10 of 11 patients. Survival rate for patients who underwent porto-appendiceal duodenostomy was 14 of 16 patients. Overall survival rate was comparable between porto-appendiceal duodenostomy (88%) and Kasai portoenterostomy (91%).


CONCLUSIONS
Although overall survival rate was comparable, patients who underwent porto-appendiceal duodenostomy were less successful in alleviating hyperbilirubinemia compared with Kasai portoenterostomy. This is shown further by the greater incidence of subsequent liver transplantation in infants with prior porto-appendiceal duodenostomy. Although the appendix may serve as an alternative biliary conduit, traditional Kasai portoenterostomy appears to achieve better biliary drainage.
Tsao
KuoJen
K
Fetal Treatment Center, Department of Surgery, Division of Pediatric Surgery, San Francisco, CA 94143-0570, USA.
Rosenthal
Philip
P
Dhawan
Kapil
K
Danzer
Enrico
E
Sydorak
Roman
R
Hirose
Shinjiro
S
Farmer
Diana L
DL
Albanese
Craig T
CT
Harrison
Michael R
MR
Lee
Hanmin
H
D000293:Adolescent; D001656:Biliary Atresia / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods*; D004385:Duodenostomy; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D011171:Portoenterostomy, Hepatic; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome