“Is surgery necessary for biliary atresia?”
My child has biliary atresia, which was conformed through an ultrasound and a biopsy. His doctor wants to perform a surgery next. Is this surgery necessary for it, or can he live with it? He's only three years old right now.
4 Answers
Yes, the younger the better.
Yes, it is definitely necessary or liver failure will eventually develop.
Yes, it's mandatory. It’s known as Kasai Procedure. Biliary atresia is a life-threatening disease, because it produces liver cirrhosis; surgery must be done before 90 days, which, in this case (3years) isn’t usual, must be another disease or age.
More information on the infant's history would be important (such as age at onset of jaundice, current age, other lab values, other illnesses). However, it is important to know that ultrasonography and liver biopsy are not definitive methods for the diagnoses of biliary atresia. These studies can be highly suggestive of biliary atresia, but severe neonatal hepatitis can yield similar findings with these studies. The definitive diagnosis of biliary atresia is initially made by a limited surgical procedure that includes an incision in the right upper part of the abdomen and visualization of the area of the gallbladder area and the major bile ducts. The gall bladder is opened and if there is a lumen (open channel) a small tube is placed in it and radiographic dye is injected to see if there is a communication from the gall bladder to the main bile ducts and that the dye extends into the bile ducts in the liver. If the dye does not reach into the liver then the diagnosis of biliary atresia is made. If the infant has biliary atresia, the surgical treatment is a portoenterostomy (commonly referred to as the Kasai procedure after the surgeon that described it). This procedure should be performed by a pediatric surgeon with experience in performing it. It can be done using laparoscopy (minimally invasive surgery), but only by a pediatric surgeon with extensive experience in performing this procedure using that approach. This is a very precise procedure. The best outcomes for success following the Kasai procedure are dependent on performing the procedure correctly the first time.
I hope this answers your question.
Marshall Z. Schwartz, MD, FACS, FRCS-Eng (Hon)
I hope this answers your question.
Marshall Z. Schwartz, MD, FACS, FRCS-Eng (Hon)
