WOFAPS 2025 8th World Congress of Pediatric Surgery

Muhammad Saleem

Akhtar Saeed Medical & Dental College, Lahore

Biliary atresia (BA) remains the most challenging neonatal cholangiopathy with significant global morbidity and mortality. This plenary presentation critically evaluates current controversies and innovations in the diagnosis and surgical management of BA, integrating evidence from high-volume centers and evolving surgical practices. Emphasis is placed on anatomical classifications, advanced diagnostic modalities—including high-resolution imaging and laparoscopic identification of subcapsular spider-like telangiectasias (HSST sign)—and intraoperative decision-making regarding extent of portal plate dissection.

The evolution of Kasai portoenterostomy (KPE) techniques is reviewed, contrasting original, modified, and extended dissections and their prognostic implications. The merits and limitations of laparoscopic versus open approaches are debated, alongside emerging data on robotic-assisted Kasai and revision strategies for failed KPE. Timing of surgery, especially within the first 60 days, and the need for individualized treatment in syndromic variants such as BASM, are emphasized as critical to improving native liver survival.

Postoperative care, the role of adjuvant steroids and antibiotics, and criteria for early liver transplantation are discussed with reference to recent global registries. Future directions including pharmacological innovations, stem cell therapy, and bile duct tissue engineering are briefly explored.

This presentation aims to provide a comprehensive, evidence-informed framework for managing biliary atresia in both high-resource and resource-constrained settings, while advocating for early screening strategies to optimize outcomes.

(NOTE: this abstract is for Expert Talk)