RESUMO
Objectives: The purpose of this study was to determine the predictors of the clinical outcome after Kasai portoenterostomy done for cases with biliary atresia [BA]
Study design: a prospective clinical study involving twenty patients with billay atresia that underwent Kasai operation. All patients underwent a detailed history taking, clinical examination and were investigated for liver function tests. US abdomen was also done in addition to preoperative liver biopsy and intra-operative cholangiogram. Patients were followed up for a period of 6 months post operatively and complications such as cholangitis, progress to liver failure and cirrhosis was noted. The schedule and indications for liver transplantation were also followed
Results: There were no mortalities within the 6 months of follow up, 11 patients showed gradual reduction of serum bilirubin [<2mg/dI] as well as liver enzymes [Non-icteric] and 9 patients' maintained high levels of serum bilirubin [>2mg/d1] and liver enzymes [Icteric].There was statistically significant difference between the two groups regarding age at operation, presence of preoperative ascites, hepatomegaly and patients' child-Pugh score. Preoperative total serum bilirubin and its direct fraction, preoperative liver enzymes [AST-ALT-GGT-alkaline phosphatase], preoperative serum albumin and total proteins, advanced pathological changes in preoperative liver biopsy showed statistically significant difference between the two groups. However; sex, splenomegaly, associated anomalies, bleeding profile, presence of preoperative TC sign and operative duration didn't show statistically significant difference between the two groups
Conclusion: Kasai portoenterostomy showed better results with short term follow up if done at an early age. Presence of ascites, hepatomegaly and advanced Child-Pugh score adversely affect the clinical outcome, Better outcome is predicted also by lower preoperative serum bilirubin with its direct fraction, lower levels of liver function tests and higher levels of plasma proteins and serum albumin. Advanced liver fibrosis and pathological changes in preoperative liver biopsy are predictors of bad outcome after Kasai portoenterostomy