Modified technique for Kasai porto-enterostomy in biliary atresia and its impact on clinical outcome

Background Traditionally, the principle of the Kasai procedure is to remove the atretic extrahepatic ducts so as to establish bile flow to the intestine at an early stage and prevent further progression of the disease. Here, we describe modifications to the procedure via a wider and deeper dissection. Aim To assess the new modified technique over the traditional technique used for type III biliary atresia and its impact on the clinical outcome. Patients and methods This is a retrospective study that assessed the outcome of 66 patients who underwent Kasai portoenterostomy (KPE) at Hepatobiliary and Pancreatic Surgery Department, National Liver Institute, Menoufia University between July 2014 and December 2017. The patients were divided into two groups and the outcome after the modified KPE were compared with the traditional KPE regarding clinical outcome and overall survival. Results In all, 66 patients were identified. Of these, 32 were in the traditional KPE group and 34 in the modified KPE group. The modified technique had better short-term clinical outcome than the traditional technique group at 3 and 6 month postoperatively with statistical significance (P=0.006 and 0.017, respectively). The rate of native liver survival was 68.8 versus 31.5% and overall survival was 88.2 versus 65.6%. Conclusion Deep and long incision in fibrous remnant and meticulous anastomosis was associated with favorable outcomes.