title: Early surgical outcomes and pathological scoring values of older infants (≥ 90 d old) with biliary atresia.
abstract: OBJECTIVE
  This study aimed to analyze the impact of age at Kasai operation on the short-term outcome of type III biliary atresia (BA) and to discuss if pathological scoring can be the prediction of effect in the Kasai procedure for the older (≥ 90 days) infant.
  
  
  METHODS
  During the period 2004 through 2010, 452 infants with type III BA were reviewed. The relationship between ages at Kasai operation and jaundice clearance rates and two year native liver survival rates were assessed, retrospectively. Pathological slides were analyzed with a histological scoring system.
  
  
  RESULTS
  All of the patients were divided into 3 groups according to their ages at operation (group A: aged 60 days or less (n=146), group B: age between 60 and 90 days (n=222) , and group C: age on or over 90 days (n=84)). The worst outcome of clearance of jaundice was found in group A but not in group C 2 weeks after the operation (P<0.05). Jaundice clearance rates showed no difference among the three groups either at 3-months or 6-months after operation. Moreover, in group C patients, the pathological scores showed no difference between the jaundice clearance group and jaundice persistence group 6 months after surgery. In group C, two year survival rate of patients with native livers was 36.1%.
  
  
  CONCLUSIONS
  Some patients over 90 days of age at surgery can still benefit from a Kasai procedure. The pathological scoring system does not play a role in predicting jaundice clearance in patients over 90 days of age at surgery.
authors.affiliation: Surgical Department, Children's Hospital of Fudan University, Shanghai 201102, China. chengongzlp@hotmail.com
authors.forename: Gong
authors.initials: G
authors.lastname: Chen
authors.forename: Shan
authors.initials: S
authors.lastname: Zheng
authors.forename: Song
authors.initials: S
authors.lastname: Sun
authors.forename: Xianmin
authors.initials: X
authors.lastname: Xiao
authors.forename: Yangyang
authors.initials: Y
authors.lastname: Ma
authors.forename: Wenjun
authors.initials: W
authors.lastname: Shen
authors.forename: Lian
authors.initials: L
authors.lastname: Chen
authors.forename: Zai
authors.initials: Z
authors.lastname: Song
mesh_terms: D000367:Age Factors; D000714:Anastomosis, Surgical / Q000379:methods; D001656:Biliary Atresia / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology; D007582:Jejunostomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D008099:Liver / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome