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Factors Influencing Outcome after Hepatic Portoenterostomy for Biliary Atresia: A Logistic Regression Analysis
Soottiporn Chittmittrapap, MD, FACS*, Bidhya Chandrakamol, MD*,
Yong Poovorawan, MD**, Pongsepeera Suwangool, MD***
* Department of Surgery, Faculty of Medicine, Chulalongkorn University
** Department of Pediatrics Faculty of Medicine, Chulalongkorn University
*** Department of Pathology, Faculty of Medicine, Chulalongkorn University
Background/Objective: The association of many factors with the outcome in Biliary atresia (BA) after hepatic portoenterostomy has drawn the attention of many pediatric hepatologists and hepatobiliary surgeons. Understanding these factors will become an important subject in prediction of the postoperative status and in indicating further proper management.
Material and Method: During the last 9 years, 159 BA babies were treated by hepatic portoenterostomy. The authors reviewed the following factors and how they related to outcome: age at operation, total bilirubin (TB) level, type of BA, postoperative bile drainage, hepatic histological features at operation, preoperative and postoperative cholangitis. A multiple logistic regression analysis was used to indicate the factors which significantly influenced the outcome.
Results: Of the 159 BA babies, clearing of jaundice confirmed by the color of stool and postoperative serum bilirubin level less than 2 mg % was observed in 54 patients (Group A). Bile drainage with mild jaundice (TB 2-5 mg%) was detected in 65 patients (Group B). The operation failed to create bile flow clinically and biochemically in 40 patients (Group C). Some patients in the last group died during follow-up due to hepatic disease. The multiple logistic regression analysis revealed that the age at operation (> 8 weeks of age), and the presence of portal and parenchymal inflammation at operation significantly related to the failure of portoenterostomy which was followed by portal hypertension with or without esophageal varices. The presence of cholangitis was also significantly related to a poor outcome.
Conclusion: The age at operation, portal and parenchymal inflammation and the presence of cholangitis are significant factors which relate to the poor prognosis of BA. Recognition of these will lead to proper long-term management
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