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TÜRKÇE
Poster - 291
Bile lake post following Kasai portoenterostomy in biliary atresia (BA): clinical course and clinical implications
Sujin Gang 1, Ju Yeon Lee 2, Seo-Hee Kim 3, Wooim Baek 4, Jung-Man Namgoong 5
1 Division of Pediatric Surgery, Department of Surgery, Ewha Womans University Seoul Hospital
2 Department of Pediatric Surgery, Chonnam National University Hospital
3 Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Chonnam National University Hospital
4 Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Asan Medical Center
5 Division of Pediatric Surgery, Department of Surgery, Asan Medical Center
Bile lake (BL) is considered as a complication with a poor prognosis in that it can be a source of recurrent cholangitis due to bile stasis. To date, the impact of BL on the course of biliary atresia (BA) is limited to evidence from each study group, and only the significance of bile lake with cholangitis is known. Therefore, in this presentation, we will retrospectively review the clinical course of children operated for BA at our center and share our experience on the impact of bile lake on the clinical course of BA.
We retrospectively reviewed medical records of 133 patients who underwent operation on BA between 1992 and 2002 in Asan Medical Center.
BL were identified in 59 patients, and more than half of them were identified in the left liver (n=28). Of these, 37 patients were treated for cholangitis associated with BL. All were treated with antibiotics except for 2 patients who underwent hepatectomy, 1 patient who underwent PTBD insertion, and 1 patient who underwent revision after HJ at first surgery. Seven of the patients did not progress to Kasai failure because the BL disappeared after treatment. However, six of these patients were found to have progressed to LC. In 29 patients, the BL persisted or worsened despite treatment, and 10 of these patients underwent LT. Of the 74 patients without a bile lake, 53 were found to have cholangitis, and 24 underwent LT.
We found that BLs were not directly associated with cholangitis (p=0.545) and BL with cholangitis was not directly associated with liver transplantation (p=0.730). It may be due to the presence of a group of patients with rapidly progressive LC without BL who underwent transplantation and advances in medical management, including antibiotics.