A Study of Prognostic Indicators in Extra-Hepatic Biliary Atresia

Abstract

Background: EHBA is a destructive sclerosing inflammatory process that initially involves extra- hepatic bile ducts, latter on involving intra- hepatic bile ducts and ultimately progresses to biliary cirrhosis. The role of various factors believed to be important for successful outcome of Kasai portoenterostomy has been debated and these include age at surgery, features of liver failure, episodes of cholangitis, etc. So the exchange of information regarding the prognostic factors is of utmost importance for early diagnosis, intervention and subsequent successful outcome.

Objectives: To evaluate the prognostic indicators in Biliary Atresia, Preoperative, Intraoperative and Post operative.

Study Design: Retrospective & Prospective Observational study.

Participants: EHBA patients as confirmed by Intraoperative cholangiogram in the time period from April 2014- June 2019.

Methods: Data regarding retrospective group of patients was retrieved from Medical Records Department SKIMS. In prospective group, all the infants suspected of EHBA were admitted in the department of Pediatric Surgery SKIMS. Diagnostic workup was done which included history, clinical presentation, biochemical, hematological & radiological investigations.

Results: Male to female ratio of 1: 1.5 was seen. Most common presenting symptoms were acholic stools (69%) , yellowish body discoloration (25%) , high coloured urine (6%) . Kasai was successful in 67% of patients with normal coagulogram, 86% of patients having presence of bile flow, 100% patients without cirrhosis, 70% of patients without ascites & 80% of patients having APRI<1.5 as compared to 50% of patients having deranged coagulogram, 50% of patients having absence of bile flow, 28% of patients having liver cirrhosis, 25 % of patients having ascites & 41% in patients having APRI >1.5.

Conclusion: Kasai operation should be done at an early age. Patients in whom features of liver failure are absent have higher chances of kasai procedure being successful.

Implications: This study can further help us in predicting the outcome of kasai procedure but the cohort of patients is small so further research on the topic is required.