Long-term outcomes after revision of Kasai portoenterostomy for biliary atresia

Background The indications for and efficacy of revision of portoenterostomy (PE) for biliary atresia (BA) needs to be reassessed in an era of liver transplantation. We therefore reviewed the long‐term outcomes following revision of PE. Methods This was a retrospective study of the medical records of patients with BA who underwent PE and revision of PE. We investigated the role of revision on outcomes of jaundice‐free native liver survival (approval number: 2015–0094). Results Portoenterostomy was performed in 76 patients, among whom 22 underwent revision. Revision for recurrent jaundice was performed for four of 51 patients, who were transiently jaundice free after initial PE, but only one achieved native liver survival. Revision for repeated cholangitis in two patients achieved native liver survival over 10 years. Revision was performed in 16 of the 25 patients in whom initial PE failed; of these, four survived with their native liver (ages 3, 12, 12, and 14 years). The PE revision did not significantly affect liver transplantation duration and survival outcome. Conclusions Revision of PE was suitable for repeated cholangitis. Revision for recurrent jaundice, regardless of whether the initial PE was successful, could have a limited but positive effect in preventing long‐term progressive liver failure. Highlight Setting out to reassess the indications for and efficacy of revision of Kasai portoenterostomy for biliary atresia in the era of liver transplantation, Shirota and colleagues reviewed the long‐term outcomes following revision. Their results confirm that revision of Kasai portoenterostomy can have a positive effect in preventing progressive liver failure.