Eur J Pediatr Surg 2021; 31(04): 335-340
DOI: 10.1055/s-0040-1713934
Original Article

Impact of Age of Patient and Experience of Surgeon on the Outcome after Kasai Portoenterostomy: Can We Delay the Surgery?

1   Department of Surgery, The Chinese University of Hong Kong, New Territories, Hong Kong
,
Kim Hung Lee
1   Department of Surgery, The Chinese University of Hong Kong, New Territories, Hong Kong
,
Hei Yi Vicky Wong
1   Department of Surgery, The Chinese University of Hong Kong, New Territories, Hong Kong
,
Siu Yan Bess Tsui
1   Department of Surgery, The Chinese University of Hong Kong, New Territories, Hong Kong
,
Jennifer Wai Cheung Mou
1   Department of Surgery, The Chinese University of Hong Kong, New Territories, Hong Kong
,
Yuk Him Tam
1   Department of Surgery, The Chinese University of Hong Kong, New Territories, Hong Kong
› Author Affiliations

Abstract

Introduction Age of patient and experience of biliary atresia (BA) center are well-known factors associated with early jaundice clearance (EJC) after Kasai portoenterostomy (KPE) in infants with BA. This study focused on the impact of age and surgeon factor on the short-term outcome after KPE within a single center.

Materials and Methods Fifty-four consecutive infants (18 boys and 36 girls) who underwent KPE from January 2010 to January 2020 were reviewed. KPE was performed in the earliest available operative session once the initial work-up was completed. In group A (n = 41), KPE was performed by surgeon A. In group B (n = 13), KPE was performed by specialists under the supervision of surgeon B (who is the mentor of surgeon A) when surgeon A was not available for operation. The demographics of patients, the EJC (total bilirubin <20 μmol/L within 6 months of KPE), and 2-year native liver survival (NLS) between the two groups were studied.

Results The median age at operation was 52 days (range 26–135 days). The overall EJC rate and 2-year NLS were 85.2 and 89.4%, respectively. Group A (p = 0.015) and male gender (p = 0.029) were statistically associated with EJC but not the age at operation (p = 0.101). Group A was also statistically associated with superior 2-year NLS (p = 0.047).

Conclusion Balancing between the impact of age at operation and the experience of surgeon on the outcome after KPE, our result suggested that KPE may be deferred until a more experienced surgeon to operate.



Publication History

Received: 06 April 2020

Accepted: 27 May 2020

Publication Date:
06 July 2020 (online)

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