Evaluation of the results of patients undergoing surgery with a diagnosis of biliary atresia

ABSTRACT Evaluation of Prognostic Factors in Patients Undergoing Surgery for Biliary Atresia Aim: This study aimed to identify the prognostic factors influencing clinical outcomes in patients who underwent surgery with a diagnosis of biliary atresia (BA). Material and Method: Patients who were diagnosed with biliary atresia and operated between January 1, 2007 and October 20, 2023 were included in the study. File information was retrospectively reviewed. Gender, date of birth, time of surgery, liver function test values at admission, preoperative period, before discharge, at 1 month and at 3 months, viral screening results, ultrasonography findings, operative notes, complications that developed during the follow-up period were analyzed and pathology preparations were re-evaluated by a senior pathologist. The APRI score were analyzed. Good prognosis was defined as survival with the patient's own liver (Group A) and poor prognosis was defined as liver transplantation or death (Group B) Results: In the specified date range, 64 patients were operated with a diagnosis of biliary atresia. Two patients were excluded from the study because their files could not be accessed. Thirty-two of the patients were female (51.6%) and 30 were male (48.4%). The mean gestational age at birth was 37.8 ± 1.2 weeks. When the APRI score of the patients was evaluated, a cut off value of 0.65 had moderate reliability in determining prognosis with a sensitivity of 74% and a specificity of 52%. The mean age at surgery in group A was 65,6±22,2 days. In group B, the mean was 78±33.2 days. The prognosis was better in cases operated early. According to the Japanese Biliary Atresia Society classification, 6 patients were type 1 (9.5%), 13 patients were type 2 (20.6%) and 44 patients were type 3 (69.8%). There was no statistical difference between the types in terms of prognosis. The effect of pathology parameters (degree of fibrosis, degree of cholestasis, degree of bile duct proliferation, presence of ductal plaque) on the prognosis of the patients could not be shown statistically. Postoperative colic stool was observed in 94.7% of Group A (good prognosis) patients. In Group B (poor prognosis) patients, this rate was significantly lower with 55.8%. Conclusion: APRI score significantly predicted both jaundice clearance and native liver survival, whereas low birth weight and late surgical intervention were associated with poor prognosis. Gender, gestational week, season of delivery, USG parameters, BA subtypes, syndromic status, CMV infection and surgical techniques were not found to affect prognosis. Keywords: Biliary Atresia, Kasai portoenterostomy prognosis, APRI score