WOFAPS 2025 8th World Congress of Pediatric Surgery

Marwan Osman ¹, Esam Taha ², Abdelrahman Elnour ³

¹ Sudan Medical Specialization Board
² Alribat University Hospital
³ National Centre of Pediateric Surgey

Purpose:
Biliary atresia is a progressive cholangiopathy and the leading indication for pediatric liver transplantation. In resource-limited settings, delayed diagnosis and limited surgical access adversely affect outcomes. This study describes the clinical presentation, management, and short-term outcomes of infants with biliary atresia in Sudan.

Methods:
A retrospective descriptive cross-sectional study was conducted across six major pediatric surgery centers in Sudan, including infants diagnosed between January 2019 and March 2024. Clinical, laboratory, imaging, operative, and outcome data were analyzed.

Results:
Eighty-four infants were included; 48 (57.1%) were male, and 44 (52.4%) were referred before 90 days of age. All presented with prolonged jaundice, acholic stools, and dark urine. In 60.7%, jaundice began in the first week of life. Diagnosis was confirmed by imaging, liver biopsy, and intraoperative cholangiography. Kasai portoenterostomy was performed in 73 infants (86.9%); 11 (13.1%) had advanced disease precluding surgery. Postoperative complications occurred in 48.8%, most commonly wound infection (21.4%) and anastomotic leak (9.5%). At discharge, 72.6% passed pigmented stools. At six months, 35.7% had favorable outcomes; mortality was 50.0%. Only 3.6% accessed liver transplantation abroad.

Conclusion:
Delayed presentation and limited transplant access compromise outcomes. Early diagnosis and improved surgical and transplant access are vital.