Journal of pediatric surgery · 2026
Surgical approach to the management of biliary atresia in the United States.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Stetson Alyssa, Sescleifer Anne M, Kahan Anastasia M, Kunisaki Shaun M, Alaish Samuel M, Padilla Benjamin, Lal Dave R, Tiao Greg, Corbitt Natasha, Slidell Mark B, Eastern Pediatric Surgery Network Collaborators, Midwest Pediatric Surgery Consortium Collaborators, Western Pediatric Surgery Research Consortium Collaborators
Аннотация
BACKGROUND: The Kasai portoenterostomy (KPE) is the only option to achieve native liver survival for patients with biliary atresia and yet technical variations exist. We surveyed members of three American pediatric surgery research consortia regarding their approach to the KPE.
METHODS: Members from the Eastern Pediatric Surgery Network (EPSN), Midwestern Pediatric Surgery Consortium (MWPSC), and Western Pediatric Surgery Research Consortium (WPSRC) developed the survey which was distributed via REDCap to consortia member institutions.
RESULTS: The survey was completed by 44/45 institutions. KPE is performed by pediatric surgeons at 41 sites (93%), a transplant surgeon at one (2%), and both at two (5%). Twenty-six sites (59%) transected into the liver capsule, 10 (23%) into the liver, two (5%) into the fibrous cord, and 6 (14%) reported variance. One site (2%) reported use of cautery in addition to sharp dissection for porta hepatis transection. The most common length for the Roux limb was 25-35 cm (16, 36%), with 14 sites (32%) creating a Roux limb < 25 cm, eight sites (18%) > 35 cm, and 6 sites (14%) responding that length varies between surgeons. Surgical diagnosis with intraoperative cholangiogram (IOC) was always performed at 33 sites (75%), and twenty-eight sites (64%) obtain both preoperative percutaneous and intraoperative biopsies. Two sites (5%) offer partially laparoscopic KPE.
CONCLUSION: In the first survey of American surgical practices for KPE, we found consensus regarding some technical aspects of the operation. However, the responses to most questions demonstrated variability. Future studies will analyze how technical variations impact national KPE outcomes.
METHODS: Members from the Eastern Pediatric Surgery Network (EPSN), Midwestern Pediatric Surgery Consortium (MWPSC), and Western Pediatric Surgery Research Consortium (WPSRC) developed the survey which was distributed via REDCap to consortia member institutions.
RESULTS: The survey was completed by 44/45 institutions. KPE is performed by pediatric surgeons at 41 sites (93%), a transplant surgeon at one (2%), and both at two (5%). Twenty-six sites (59%) transected into the liver capsule, 10 (23%) into the liver, two (5%) into the fibrous cord, and 6 (14%) reported variance. One site (2%) reported use of cautery in addition to sharp dissection for porta hepatis transection. The most common length for the Roux limb was 25-35 cm (16, 36%), with 14 sites (32%) creating a Roux limb < 25 cm, eight sites (18%) > 35 cm, and 6 sites (14%) responding that length varies between surgeons. Surgical diagnosis with intraoperative cholangiogram (IOC) was always performed at 33 sites (75%), and twenty-eight sites (64%) obtain both preoperative percutaneous and intraoperative biopsies. Two sites (5%) offer partially laparoscopic KPE.
CONCLUSION: In the first survey of American surgical practices for KPE, we found consensus regarding some technical aspects of the operation. However, the responses to most questions demonstrated variability. Future studies will analyze how technical variations impact national KPE outcomes.