Technical standardization of Kasai portoenterostomy for biliary atresia

Background: The purpose of this study was to assess the clinical outcome of patients treated with the current technique of Kasai procedure compared with that of those treated with previous procedures. Methods: We retrospectively assessed the outcomes of 256 patients with biliary atresia who underwent Kasai portoenterostomy at our hospital between 1972 and 2014. Patients were divided into four groups: group 1 (1972-1981, double Roux-en Y, n = 91), group 2 (1982-1991, Suruga II, n = 80), group 3 (1992-2000, double-valve Roux-en Y, n = 46), and group 4 (2001-2014, total removal of the extrahepatic biliary remnants at hepatic capsule and Roux-en Y reconstruction with a spur valve, n = 39). Clinical outcomes were compared between the four groups. Results: In groups 1, 2, 3, and 4, the rate of jaundice clearance was 65.9%, 77.5%, 63.0%, and 87.2%, respectively; incidence of early cholangitis was 60.4%, 53.8%, 37.0%, and 23.1%, respectively; requirement for redo Kasai surgery was 15.4%, 37.5%, 17.4%, and 5.1%, respectively; 10-year native liver survival rate was 53.8%, 60.1%, 44.1%, and 73.7%, respectively; and 10-year overall survival rate was 55.0%, 72.3%, 86.7%, and 97.3%, respectively. Conclusion: The standardized Kasai procedure was associated with favorable outcomes. Long-term outcomes remain to be evaluated. Level of evidence: Case-control/treatment study, level III. (C) 2016 Elsevier Inc. All rights reserved.