title: Inguinal Hernias Represent the Most Frequent Surgical Complication after Kasai in Biliary Atresia Infants.
abstract: Biliary atresia (BA) is an orphan medical condition of the newborn, resulting in end-stage liver cirrhosis due to obliterative cholangiopathy of the extrahepatic bile duct. Although Kasai's hepatoportoenterostomy (KPE) is the well-established first-line therapy, little is known about its surgical complications. 153 patients receiving open KPE treated at a single center between 1994 and 2014 were analysed retrospectively regarding short-term complications and survival with the native liver. In brief, 40.5% of patients suffered from 1-3 surgical complications, inguinal hernias (IH) being most prevalent (40.0%). In BA patients, incidence of IH was associated with male gender (p = 0.002), the syndromic form of BA (p = 0.038), and percutaneous drainage for ascites (p = 0.002). No association was found with prematurity (p = 0.074) or birth weight (p = 0.912) in our study. In conclusion, IH frequently develops after open KPE of BA patients, but this complication does not negatively affect the patient's outcome. Nevertheless, inspection of the internal inguinal ring and prophylactic closure of inapparent hernias should be discussed in order to prevent secondary surgical procedures.
authors.affiliation: Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
authors.forename: Omid
authors.initials: O
authors.lastname: Madadi-Sanjani
authors.affiliation: Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Carl
authors.affiliation: Institute of Pathology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Longerich
authors.affiliation: Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Petersen
authors.affiliation: Institute of Pathology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Julia H K
authors.initials: JH
authors.lastname: Andruszkow
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000401:mortality*; D001656:Biliary Atresia / Q000401:mortality* / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006552:Hernia, Inguinal / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D035583:Rare Diseases / Q000401:mortality / Q000601:surgery; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome