Portal hypertension in biliary atresia after kasai portoenterostomy

Background/Purpose: Our aim is to characterize the clinical outcome to portal hypertension of biliary atresia after Kasai portoenterostomy, comparing children who had good biliary drainage with those who had poor drainage after the procedure. Methods: We performed a retrospective chart review of 44 children with biliary atresia submitted to Kasai portoenterostomy from 1986 through 2002, dividing them according to the post operative serum bilirubin value, and compared their outcome to portal hypertension. Results: Eighteen children (40.1%) showed good biliary drainage with a median age of 9.45 weeks while 26 (58.9%) showed poor or partial drainage with a median age of 11.5 weeks at the Kasai portoenterostomy (p=0.05). Ascites and thrombocytopenia appeared earlier in the poor drainage group. Detection of esophageal varices and its bleeding showed no statistical difference between the two groups. Conclusion: Good biliary drainage after the Kasai portoenterostomy postpones the advent of portal hypertension signs, but it does not avert the onset of esophageal varices nor its bleeding. Index words: Biliary atresia, Kasai portoenterostomy, portal hypertension, esophageal varices.