Hepatic Portocholecystostomy

Hery, G.; Gonzalès, Emmanuel; Bernard, Olivier; Fouquet, Virginie; Gauthier, F.; Branchereau, Sophie

doi:10.1097/mpg.0000000000001685

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…But none has proven entirely satisfactory in terms of eliminating cholangitis. A retrospective study of 97 cases that underwent gallbladder Kasai from a single institution reported 46% of the patients to be jaundice free with their native liver after 5 years of follow-up ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Kasai Operation in Biliary Atresia After Extensive Bowel Resection

Chen

Chang

et al. 2022

Front. Surg.

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Biliary atresia (BA) is a major and devastating cholestatic liver disease in infancy. The Kasai procedure is an operation to re-establish bile flow from the liver into the intestine that can prevent the young infant from progressing rapidly to cirrhosis. The standard Kasai procedure includes the removal of extrahepatic bile duct remnants and reconstruction. We report a case of BA with short bowel due to previous small intestinal volvulus. This full-term female infant received extensive small bowel resection after birth due to intestinal volvulus. The length of the residual small bowel was 55 cm with an intact ileocecal valve. Because of progressive cholestasis and clay stool, another laparotomy was performed under the diagnosis of BA on the 52 days old. After dissection of the hepatic portal area, a segment of the colon instead of intestine was used as a biliary conduit to avoid further shortening her small bowel. The patient recovered from the procedure uneventfully and the parenteral nutrition was discontinued 2 weeks later. Two episodes of cholangitis happened after discharge. She gradually resumed body weight gain and the bilirubin level returned to normal range 6 months after the operation. This unique case demonstrated successful use of this specific procedure in the patient with BA and short bowel that have never been reported in the literature.

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Section: Discussionmentioning

confidence: 99%

Case Report: Kasai Operation in Biliary Atresia After Extensive Bowel Resection

Chen

Chang

et al. 2022

Front. Surg.

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“…Cholangiography is essentially redundant here, in that it will inevitably show a patent common bile duct into the duodenum but no sign of a more proximal biliary tree. Some centres, particularly in France, would consider a portocholecystostomy (i.e., the gallbladder opened and anastomosed to the transected portal plate) for BA to make use of this feature [ 20 ]. This option effectively abolishes the risk of post-operative cholangitis, although has a higher revision rate for leaks and obstruction.…”

Section: Discussionmentioning

confidence: 99%

Surgical and Medical Aspects of the Initial Treatment of Biliary Atresia: Position Paper

Davenport

Madadi-Sanjani

Chardot

et al. 2022

JCM

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Biliary atresia, a fibro-obliterative disease of the newborn, is usually initially treated by Kasai portoenterostomy, although there are many variations in technique and different options for post-operative adjuvant medical therapy. A questionnaire on such topics (e.g., open vs. laparoscopic; the need for liver mobilisation; use of post-operative steroids; use of post-operative anti-viral therapy, etc.) was circulated to delegates (n = 43) of an international webinar (Biliary Atresia and Related Diseases—BARD) held in June 2021. Respondents were mostly European, but included some from North America, and represented 18 different countries overall. The results of this survey are presented here, together with a commentary and review from an expert panel convened for the meeting on current trends in practice.

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“…Little has changed in the surgical technique of HPE since Kasai’s initial descriptions. Alternative techniques, such as drainage using the gallbladder, have been explored but were determined to have limited application …”

Section: Introductionmentioning

confidence: 99%

“…Alternative techniques, such as drainage using the gallbladder, have been explored but were determined to have limited application. 4 The rate of survival with native liver after a BED treatment is 37.9% to 40% after 5 years and decreases to 25% to 32.1% after 15 years, even at experienced centers and despite considerable efforts to improve the long-term outcomes. [5][6][7] Mortality occurs secondary to progressive hepatic injury, which leads to cirrhosis and end-stage liver disease that eventually require LT in most patients.…”

mentioning

confidence: 98%