Robert Cowles; Jason S. Frischer, MD; R. Peter Altman, MD
Introduction: Outcomes for children with biliary atresia have improved over the last 40 years. Development of the Kasai hepatoportoenterostomy (KP) and advancements in pediatric liver transplantation (LT) are key reasons for this improvement. Our group has performed KP since the 1970s. This video illustrates our current technique.
Methods: The 30 day old child developed jaundice and acholic stools. Evaluation revealed direct and indirect hyperbilirubinemia. Abdominal ultrasound demonstrated a contracted gallbladder and HIDA scan failed to show isotope excretion into the intestine. Liver biopsy showed ductal proliferation, acute and chronic inflammation and inspissated bile. A diagnosis of biliary atresia was made and exploration with KP was recommended.
Results: The KP was performed at age 45 days. The video highlights important aspects of this operation. The abdomen was explored via a transverse incision. Biliary remnants were inspected to confirm the diagnosis. The remnant of the common bile duct was divided above the duodenum. This remnant was dissected toward the bifurcation of the portal vein until the portal plate was identified. Dissection and division of the portal plate, and creation of the roux limb are described in detail. The jejuno-portal anastomosis concludes the main portions of the case. Details such as closure of the roux limb mesentery are discussed. An oral diet began on postoperative day 3 and discharge was on postoperative day 5. At 3 months, the stools are pigmented and jaundice has cleared.
Conclusion: The KP has evolved since its introduction. Our technique appears to afford excellent outcome without adverse effect on future LT, if necessary.