title: The extended Kasai portoenterostomy for biliary atresia: A preliminary report.
abstract: OBJECTIVE
  In 1955, Professor Morio Kasai first performed a hepatic portoenterostomy. Since then, the procedure has changed the lives of children with biliary atresia (BA). We report our initial experience in performing "extended" Kasai portoenterostomy (KPE), a modification of the original procedure.
  
  
  METHODS
  Since 2013, we have used the technique of "extended KPE" and prospectively recorded data on all children undergoing this operation. Data on demographics, clinical features, liver function tests, and perioperative cholangiogram findings were collected. Outcome of KPE was measured by Jaundice Disappearance Rate (JDR) and Native Liver Survival Rate (NLSR). We present our preliminary results from a 30-month period (February 2013 to May 2015).
  
  
  RESULTS
  Thirty-one children underwent KPE during this period (19 males) and only 1 child had biliary atresia splenic malformation (BASM). The mean age at KPE was 73 ± 24 days. Five (16.1%) children were more than 90 days old at the time of KPE. Fourteen children cleared jaundice (JDR 45.2%). Eleven (35.5%) children developed episodes of cholangitis, of whom 8 had early cholangitis (within 3 months of the operation). The proportion of children who survived with their own liver 6 months after KPE (NLSR) was 84.2%. Of those children older than 90 days, 2 cleared jaundice and have survived with their native livers for more than 16 months.
  
  
  CONCLUSIONS
  In our preliminary report of 31 children, we conclude that the extended KPE leads to increased jaundice clearance and improved NLSR in children with BA.
authors.affiliation: Institute of Liver Disease and Transplantation, Global Health City, Chennai, Tamil Nadu, India; Department of Pediatric Surgery, Kanchi Kamakoti CHILDS Trust Hospital, CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India; National Foundation for Liver Research, Chennai, Tamil Nadu, India.
authors.forename: Priya
authors.initials: P
authors.lastname: Ramachandran
authors.affiliation: Institute of Liver Disease and Transplantation, Global Health City, Chennai, Tamil Nadu, India.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Safwan
authors.affiliation: Department of Pediatric Surgery, Kanchi Kamakoti CHILDS Trust Hospital, CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Sankaranarayanan
authors.initials: S
authors.lastname: Srinivas
authors.affiliation: Institute of Liver Disease and Transplantation, Global Health City, Chennai, Tamil Nadu, India; National Foundation for Liver Research, Chennai, Tamil Nadu, India.
authors.forename: Naresh
authors.initials: N
authors.lastname: Shanmugam
authors.affiliation: Institute of Liver Disease and Transplantation, Global Health City, Chennai, Tamil Nadu, India.
authors.forename: Mukul
authors.initials: M
authors.lastname: Vij
authors.affiliation: Institute of Liver Disease and Transplantation, Global Health City, Chennai, Tamil Nadu, India; National Foundation for Liver Research, Chennai, Tamil Nadu, India.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
keywords: Biliary atresia (BA); Kasai portoenterostomy (KPE); jaundice clearance; native liver survival