Tentative Proposal of Optimal Timing of Kasai Operation for Biliary Atresia Based on Fibroscan Results

Hwa Young Lee; Young A Park; Seok Joo Han; Hong Koh

doi:10.5223/kjpgn.2011.14.1.74

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Lee, Park, Han, and Koh: Tentative Proposal of Optimal Timing of Kasai Operation for Biliary Atresia Based on Fibroscan Results

Original Article

Liver & Bile Duct

Korean Journal of Pediatric Gastroenterology and Nutrition

Korean Journal of Pediatric Gastroenterology and Nutrition 2011; 14(1): 74-80.

Published online: 31 March 2011

DOI: https://doi.org/10.5223/kjpgn.2011.14.1.74

Tentative Proposal of Optimal Timing of Kasai Operation for Biliary Atresia Based on Fibroscan Results

Hwa Young Lee, M.D.^*, Young A Park, M.D.^*, Seok Joo Han, M.D.^†,^‡, Hong Koh, M.D.^*,^‡

^*Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.

^†Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

^‡Severance Pediatric Liver Disease Research Group, Seoul, Korea.

Corresponding author (KHONG@yuhs.ac)

Received 13 August 2010 Revised 10 September 2010 Accepted 10 September 2010

Abstract

Purpose

Based on previous research findings, it is well-known that the timing of surgery is generally considered the most important prognostic factor for a Kasai portoenterostomy, the primary treatment for biliary atresia. This research aimed to identify the optimal timing of a Kasai portoenterostomy and to verify if the proposed optimal timing corresponds to previous studies. All patients were classified by the timing of surgery, and pre- and post-operative fibrotic changes of the liver were measured with the elasticity value from fibroscans.

Methods

The stiffness scores of the pre- and post-operative fibroscans in 34 patients who were treated by Kasai portoenterostomy from October 2007 to September 2010 in Severance children's hospital were reviewed.

Results

The earlier the patients were treated by Kasai portoenterostomy, the lower the fibroscan scores. When the patients were treated prior to the 8th week, the post-operative scores of the fibroscans were significantly better than those patients who were treated after the 8th week, and some even recovered partially. Moreover, when operated before the 8th week, the differences between each pre- and post-operative fibroscan score also showed statistical relevance (p=0.0002).

Conclusion

The earlier the patient was treated by Kasai portoenterostomy, the less liver fibrosis that developed, the lower the level of post-operative fibrosis, and the less the degree of fibrotic progress before and after the operation. Thus, this research proposal reconfirms once more that the 8th week is the optimal timing for a Kasai portoenterostomy.

Keywords: Biliary atresia, Liver fibrosis, Fibroscan

Figures and Tables

Table 1

Baseline Characteristics of Patients

All data were given as mean±SD.

Table 2

Comparison with Pre- and Post-operative Stiffness Scores of Liver according to Each Age Group of Kasai Operation

^*Pre-LSS, liver stiffness scores of pre-operation, ^†Post-LSS, liver stiffness scores of post-operation, ^‡p-value refers to the differences of values of pre- and post-operative fibroscan scores in each age group.

Table 3

Comparison of Stiffness Scores between Pre- and Post-operation according to Each Age Group of Kasai Operation

^*p-value refers to the differences of delta values which come from each pre- and post-operation fibroscan scores (post score -pre score=each delta value of patient) in each age group.

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