Surgical treatment for intractable cholangitis with left-sided biliary cysts followed by Kasai operation in biliary atresia

Abstract

AbstractBackground: 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: In 28 of 129 patients, IBCs were identified by an imaging study (21.7%). Among them, five 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 five patients had IBCs confined to the left lateral lobe, and in one patient, the IBCs were in the hepatic hilum. All five patients experienced more than one cholangitis. Although they received intravenous antibiotic treatment and percutaneous transhepatic cholangiodrainage (PTCD) as treatment, they were intractable. Three patients underwent hepatectomy, and two underwent cystojejunostomy. There was no recurrence of cholangitis during the median follow-up period of 2.9 years.Conclusions: Surgical treatment for IBCs after KPE could be considered a safe and effective surgical procedure for children if appropriate indications are applied.