Peri-Kasai portoenterostomy sutures anchoring the jejunal loop to Glisson capsule: A novel modification to reduce the incidence of cholangitis

Background: Kasai portoenterostomy (KPE) is the standard surgical management for biliary atresia (BA).
To improve the outcome these infants were operated on within the first two months of life. The success
of the procedure is reflected by clearance of jaundice and either absence or occurrence of fewer attacks of
cholangitis. The failure of the procedure indicates liver transplantation (LT).
Objective: to reduce the incidence of the recurrent attacks of cholangitis by peri-KPE sutures anchoring
the jejunal loop to the Glisson capsule.
Methods: It is a retrospective study that included 45 infants diagnosed with BA and who were operated
on at an age younger than 60 days. They were categorized into two groups, Group A (n ¼ 23) included
infants treated with the classic KPE, and Group B (n ¼ 22) included infants treated in the same way plus
peri KPE sutures anchoring the jejunal loop to the Glisson capsule.
Results: The mean operative time in Group A was 149.3 min versus 164.8 min in Group B (p-value 0.039).
The mean level of bilirubinwas 2.2 versus 2.1 in Group A and Group B respectively at two years follow up.
The total attacks of cholangitis per patient were significantly lower in Group B than in Group A (cutoff
value ¼ 3), which was reflected by the significant reduction of the incidence of LT in Group B.
Conclusion: peri KPE sutures anchoring the jejunal loop to the Glisson capsule significantly reduced the
incidence of recurrent attacks of cholangitis and subsequently decreased the requirement of LT on the
short-term follow-up