J Pediatr Surg 1990 Jan;25(1):153-60; discussion 160-2

Optimal therapy for patients with biliary atresia: portoenterostomy ("Kasai
procedures) versus primary transplantation

Wood RP, Langnas AN, Stratta RJ, Pillen TJ, Williams L, Lindsay S, Meiergerd D,
Shaw BW Jr
Department of Surgery, University of Nebraska Medical Center, Omaha 68105
Abstract
As the results with liver transplantation have improved, a controversy has
arisen regarding the precise role of a portoenterostomy in the treatment of
infants with biliary atresia. The controversy centers around three issues: (1)
the short- and long-term survival rates achieved with both procedures, (2) the
influence of a portoenterostomy on a subsequent transplant, and (3) the shortage
of suitable liver donors for very small infants. To address these questions, we
retrospectively reviewed the charts of 48 children with biliary atresia who
underwent liver transplantation and compared these results with 35 children
transplanted for other liver diseases. As a group, the biliary atresia patients
had significantly lower mean body weights and ages and spent a significantly
longer time on the waiting list. In addition, significantly more of the biliary
atresia patients had undergone prior abdominal surgery when compared with the
non-biliary atresia group. There was no difference in the intraoperative
variables of mean anesthesia time, mean operative time, mean anesthesia
preparation time, nor the mean amount of blood transfused intraoperatively
between the two groups. However, when the biliary atresia patients who had
undergone a portoenterostomy with a stoma were compared with either the biliary
atresia patients who did not have a stoma created as part of their
portoenterostomy or the non-biliary atresia patients, significant differences
were noted in mean total anesthesia time, mean operative time, and the mean
amount of blood transfused intraoperatively. The survival rate of the biliary
atresia patients was significantly greater than the non-biliary atresia
patients.(ABSTRACT TRUNCATED AT 250 WORDS)