Is performing the Kasai portoenterostomy in the neonatal period associated with a better prognosis? A single-center, retrospective cohort study from China.

Background/purpose: This study aimed to evaluate discrepancies in prognosis after the Kasai portoenterostomy (KPE) procedure between neonatal and non-neonatal periods among patients undergoing the KPE procedure less than 60 days after birth (≤ 60 days).

Methods: All type III BA patients who performed KPE less than 60 days from June 2020 to May 2024 in the Department of Neonatal Surgery of Beijing Children's Hospital were retrospectively reviewed. They were divided into two groups according to the age at Kasai: the early KPE group (EK group, or neonatal group ≤ 30 days after birth) and the late KPE group (LK group, or non-neonatal group 31-60 days after birth), to evaluate the effect of surgical age on the postoperative efficacy following Kasai.

Results: 61 BA patients were included in our study. The median age at KPE in the EK group was 14.0 [10.0, 20.0] days and 47.0 [36.8, 51.1] days in the LK group. Regarding postoperative complications, Patients in the EK group tended to have a higher incidence of postoperative intestinal obstruction (10.5% vs. 0.0%, p = 0.033) compared to those in the LK group. However, the postoperative long-term prognosis of KPE in the EK group seemed much better than in the LK group. Compared to the LK group, a significantly greater proportion of patients in the EK group achieved successful jaundice clearance (84.2% vs. 40.5%, p = 0.002) and successful bile acids clearance (63.2% vs. 19.0%, p = 0.001). Additionally, the one-year NLS in the EK group was also higher than the LK group despite without statistically significant difference (88.2% vs. 61.5%, p = 0.046). Kaplan-Meier curve also showed a significant difference between the two groups (p = 0.049, HR = 3.91, 95%Cl 1.46-10.46). Further, we evaluate the changes in biochemical indexes and liver hardness indicators over time in BA patients who had achieved one-year NLS. We found that compared to BA patients in the LK group, those in the EK group exhibited faster jaundice clearance and bile acids clearance, and more normalized biochemical indicators and liver hardness one year after Kasai.

Conclusion: Performing KPE procedure in the neonatal period was associated with a better long-term prognosis despite of potential increased risk of postoperative adhesive ileus.