Delphi Method Analysis and Consensus of Prevalent Distinctive Practices for Biliary Atresia Management after Kasai Portoenterostomy

• Published in: Journal of Indian Association of Pediatric Surgeons 2024-05, Vol.29 (3), p.271-276
• Main Authors: Vutukuru, Sravanthi, Solanki, Shailesh, Kanojia, Ravi Prakash
• Format: Article
• Language: English
• Subjects: biliary atresia; delphi method; ganciclovir; kasai portoenterostomy; Original; phenobarbitone; Questionnaires; steroids; ursodeoxycholic acid
• ISSN: 0971-9261; 1998-3891
• DOI: 10.4103/jiaps.jiaps_250_23

Extrahepatic biliary atresia (BA) is seen in infants, with an incidence of 1 in 15,000 live births. The presentation is progressive jaundice, dark-colored urine, and clay-colored stools. Kasai portoenterostomy (KPE) is the commonly performed surgical procedure in these patients. Postoperatively, phenobarbitone, ursodeoxycholic acid (UDCA), steroids, and other drugs are given to improve bile drainage and prevent inflammation and fibrosis. However, a definitive protocol regarding the need for different drugs, dosage, and duration varies across individual surgeons and centers. No universally accepted protocol exists for postoperative management after KPE. The aim of this study was to know the prevailing postoperative management of BA by subject experts and use the Delphi process to know if the experts want to change their practice based on the results from the survey. A questionnaire was made after discussing with two experts in the field of BA. The questionnaire was mailed to 25 subject experts. The first survey data were analyzed and shared with all responders. In the second survey, change in the management based on the results from the first survey was assessed. The Delphi questionnaire was answered by 17 experts. Postoperatively, prophylactic antibiotics are prescribed for 6-12 weeks by around 40% and >12 weeks by 30% of respondents. Phenobarbitone is prescribed for