Biliary cysts in children with biliary atresia after Kasai procedure.

Abstract

Objective: This study aims to evaluate the treatment outcomes of biliary cysts in children with biliary atresia (BA) after undergoing the Kasai procedure.

Methods: A case series study on all cases were diagnosed with biliary cysts following the Kasai procedure and treated at Children's Hospital 2 from January 2017 to December 2022.

Results: A total of 29 pediatric patients were included in the study, of which 17 were female. The average time of biliary cyst detection post-Kasai procedure was 22.2 months. Solitary cysts accounted for 34.5% of the cases, while multiple cysts accounted for 65.5%. 26/29 patients (89.7%) presented with jaundice. A total of 93.1% (27/29) of cases presented with cholangitis, of which 12 responded well to intravenous antibiotics. 6/27 patients required percutaneous transhe-patic biliary drainage (PTBD) (three of which were successful, one patient underwent cyst-enteric anastomosis, one patient needed liver transplantation, and one case resulted in death due to infection). In total, six patients underwent liver transplantation, and five patients died due to infection-related complications.

Conclusions: Biliary cysts after the Kasai procedure are frequently associated with jaundice and cholangitis and require treatment in the majority of cases. PTBD combined with intravenous antibiotics is an effective treatment for simple cysts and can be considered for more complex cysts when liver transplantation is not immediately feasible.