Masaki Nio1, Motoshi Wada2, Hideyuki Sasaki2, Hiromu Tanaka2. 1. Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Aobaku, Sendai, 980-8574, Japan. mnio@ped-surg.med.tohoku.ac.jp. 2. Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Aobaku, Sendai, 980-8574, Japan.
Abstract
PURPOSE: Some patients with cystic biliary atresia (BA) achieve exceptionally good postoperative courses. Early differentiation of pediatric patients with the favorable-type disease can lead to beneficial long-term postoperative management. We examined whether the hepatic hilum morphology affects long-term prognosis in type I/I cyst BA, atresia of the common bile duct with/without a cyst. METHODS: Of 253 BA patients identified since 1972, 40 were classified as having type I/I cysts and were divided into two subtypes according to hepatic duct size (subtype α: n = 18; duct diameter, ≥ 1 mm and subtype β: n = 22; duct diameter, <1 mm) to compare postoperative clinical courses. RESULTS: In subtypes α and β, jaundice disappeared in 16 (89 %) and 19 (86 %) patients, respectively (p = 0.81), and 13 (72 %) and 12 (55 %) survived with native livers (p = 0.18) at a mean age of 23.3 and 25.5 years, respectively (p = 0.42). CONCLUSIONS: There were no significant differences in long-term outcomes between subtypes α and β, although approximately 40 % developed liver failure during the postoperative course. Thus, close long-term follow-up is essential in type I/I cysts, regardless of the hepatic hilum morphology.
PURPOSE: Some patients with cystic biliary atresia (BA) achieve exceptionally good postoperative courses. Early differentiation of pediatric patients with the favorable-type disease can lead to beneficial long-term postoperative management. We examined whether the hepatic hilum morphology affects long-term prognosis in type I/I cyst BA, atresia of the common bile duct with/without a cyst. METHODS: Of 253 BA patients identified since 1972, 40 were classified as having type I/I cysts and were divided into two subtypes according to hepatic duct size (subtype α: n = 18; duct diameter, ≥ 1 mm and subtype β: n = 22; duct diameter, <1 mm) to compare postoperative clinical courses. RESULTS: In subtypes α and β, jaundice disappeared in 16 (89 %) and 19 (86 %) patients, respectively (p = 0.81), and 13 (72 %) and 12 (55 %) survived with native livers (p = 0.18) at a mean age of 23.3 and 25.5 years, respectively (p = 0.42). CONCLUSIONS: There were no significant differences in long-term outcomes between subtypes α and β, although approximately 40 % developed liver failure during the postoperative course. Thus, close long-term follow-up is essential in type I/I cysts, regardless of the hepatic hilum morphology.
Authors: Riccardo Superina; John C Magee; Mary L Brandt; Patrick J Healey; Greg Tiao; Fred Ryckman; Frederick M Karrer; Kishore Iyer; Annie Fecteau; Karen West; R Cartland Burns; Alan Flake; Hanmin Lee; Jeff A Lowell; Pat Dillon; Paul Colombani; Richard Ricketts; Yun Li; Jeffrey Moore; Kasper S Wang Journal: Ann Surg Date: 2011-10 Impact factor: 12.969