title: Long-term outcomes after revision of Kasai portoenterostomy for biliary atresia.
abstract: BACKGROUND
  The indications for and efficacy of revision of portoenterostomy (PE) for biliary atresia (BA) needs to be reassessed in an era of liver transplantation. We therefore reviewed the long-term outcomes following revision of PE.
  
  
  METHODS
  This was a retrospective study of the medical records of patients with BA who underwent PE and revision of PE. We investigated the role of revision on outcomes of jaundice-free native liver survival (approval number: 2015-0094).
  
  
  RESULTS
  Portoenterostomy was performed in 76 patients, among whom 22 underwent revision. Revision for recurrent jaundice was performed for four of 51 patients, who were transiently jaundice free after initial PE, but only one achieved native liver survival. Revision for repeated cholangitis in two patients achieved native liver survival over 10 years. Revision was performed in 16 of the 25 patients in whom initial PE failed; of these, four survived with their native liver (ages 3, 12, 12, and 14 years). The PE revision did not significantly affect liver transplantation duration and survival outcome.
  
  
  CONCLUSIONS
  Revision of PE was suitable for repeated cholangitis. Revision for recurrent jaundice, regardless of whether the initial PE was successful, could have a limited but positive effect in preventing long-term progressive liver failure.
authors: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, Aichi, 466-8550, Japan.
authors: Chiyoe
authors: C
authors: Shirota
authors: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, Aichi, 466-8550, Japan.
authors: Hiroo
authors: H
authors: Uchida
authors: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, Aichi, 466-8550, Japan.
authors: Yasuyuki
authors: Y
authors: Ono
authors: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, Aichi, 466-8550, Japan.
authors: Naruhiko
authors: N
authors: Murase
authors: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, Aichi, 466-8550, Japan.
authors: Takahisa
authors: T
authors: Tainaka
authors: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, Aichi, 466-8550, Japan.
authors: Kazuki
authors: K
authors: Yokota
authors: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, Aichi, 466-8550, Japan.
authors: Kazuo
authors: K
authors: Oshima
authors: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, Aichi, 466-8550, Japan.
authors: Ryo
authors: R
authors: Shirotsuki
authors: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, Aichi, 466-8550, Japan.
authors: Akinari
authors: A
authors: Hinoki
authors: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, Aichi, 466-8550, Japan.
authors: Hisami
authors: H
authors: Ando
mesh_terms: D001656:Biliary Atresia / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D012086:Reoperation / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: Biliary atresia; Jaundice; Kasai portoenterostomy; Liver transplantation; Revision