The intussusception antireflux valve is ineffective for preventing cholangitis in biliary atresia: a prospective study.
OBJECTIVE
Cholangitis after Kasai portoenterostomy for biliary atresia (BA) strongly influences outcome, and an intussusception antireflux valve (IAV) in the Roux-en-Y limb has been advocated for the prevention of cholangitis without definitive evidence. The authors report a prospective study to evaluate the effectiveness of IAV in BA.


METHODS
Twenty-one consecutive patients with uncorrectable-type BA were the subjects for this study. IAV was included based on informed parental request to give 2 groups: IAV- (n = 11) and IAV+ (n = 10). The incidence/duration of episodes of cholangitis (temperature > 38 degrees C, elevated serum bilirubin level, and leukocytosis) during the first 6 months after Kasai were statistically compared between the 2 groups (P >.05 was regarded as not significant).


RESULTS
Technical variations in surgical technique were minimized because the same surgeon supervised all procedures. There were no significant differences between the 2 groups for age and weight at the time of Kasai, mean size of bile ductules at the porta hepatis, and degree of liver cirrhosis present. Protocols for antibiotic and steroid therapy were the same for both groups. The total number of patients who had cholangitis in the IAV- group was 6 of 11 and 5 of 10 in the IAV+ group (P = NS). The total number of episodes of cholangitis was 16 in the IAV- group versus 17 in the IAV+ group (P value, not significant). The mean duration of an episode of cholangitis (number of days per number of episodes) was 12 +/- 6 days in the IAV- group versus 11 +/- 7 days in the IAV+ group (P value, not significant).


CONCLUSIONS
IAV does not make any significant impact on the incidence or duration of cholangitis in the early post-Kasai period.
Ogasawara
Yuki
Y
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Yamataka
Atsuyuki
A
Tsukamoto
Kanako
K
Okada
Yasuhiro
Y
Lane
Geoffrey J
GJ
Kobayashi
Hiroyuki
H
Miyano
Takeshi
T
D000713:Anastomosis, Roux-en-Y / Q000295:instrumentation; D001655:Bile Reflux / Q000150:complications / Q000517:prevention & control*; D001656:Biliary Atresia / Q000601:surgery*; D002761:Cholangitis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D007443:Intussusception; D007565:Jaundice / Q000209:etiology / Q000517:prevention & control; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies