Ann Surg Treat Res.  2024 Dec;107(6):363-368. 10.4174/astr.2024.107.6.363.

Surgical treatment for intractable cholangitis with intrahepatic biliary cysts followed by Kasai operation in biliary atresia: a retrospective cohort study

• Cho YJ
• Kwon H
• Kwon YJ
• Ha S
• Kim SC
• Kim DY
• Namgoong JM

• KMID: 2562312
• DOI: http://doi.org/10.4174/astr.2024.107.6.363

Abstract

Purpose
Intrahepatic biliary cysts (IBCs) after Kasai portoenterostomy (KPE) are associated with intractable recurrent cholangitis. This study aimed to investigate the feasibility of its use as well as indication for surgical management of IBCs in pediatric patients.
Methods
We retrospectively reviewed the medical records and imaging studies of patients who underwent KPE for biliary atresia from 2010 to 2020.
Results
An imaging study identified IBCs in 28 of 129 patients who underwent KPE with biliary atresia (21.7%). Among them, 5 patients were subjected to surgical treatment for intractable cholangitis. The median time from KPE to the development of IBCs was 1.7 years. Four out of 5 patients had IBCs confined to the left lateral lobe, and in one patient, the IBCs were in the hepatic hilum. All 5 patients experienced more than one cholangitis. Although they received intravenous antibiotic treatment and percutaneous transhepatic cholangiodrainage as treatment, they were intractable. Three patients underwent hepatectomy, and 2 underwent cystojejunostomy. There was no recurrence of cholangitis during the median follow-up period of 2.9 years.
Conclusion
Surgical treatment for IBCs after KPE could be considered a safe and effective surgical procedure for children if appropriate indications are applied.

Keyword

Biliary atresia; Cholangitis; Hepatic portoenterostomy; Pediatrics

Figure

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  Fig. 1 Preoperative MRI of case 1. Multiple intrahepatic bile cysts were in the left lobe of the liver (arrow).

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  Fig. 2 MRI of case 4. 1 year after the Kasai portoenterostomy. Multiple cysts in the hepatic hilum were found.

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