Medical management of the 'failing' Kasai portoenterostomy

The only effective treatment for 'failing' Kasai portoenterostomy is liver transplantation (LT). However, to maximise a patient's chances to achieve the proclaimed >95% survival with sequential surgical management, medical follow-up and treatment must be planned carefully. This inc...

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Bibliographic Details
Published in:South African medical journal 2012-11, Vol.102 (11 Pt 2), p.868-871
Main Author: Hadzic, Nedim
Format: Article
Language:English
Subjects:
Biliary atresia
Biliary Atresia - surgery
Care and treatment
Children
Cholangitis - etiology
Complications and side effects
Diagnosis
Dietary Supplements
Enterostomy
Health aspects
Hepatopulmonary Syndrome - etiology
Humans
Hypertension, Portal - complications
Hypertension, Portal - etiology
Hypertension, Portal - therapy
Liver
Liver Transplantation
Nutritional Support
Physiological aspects
Portoenterostomy, Hepatic
Treatment Failure
Vitamins - therapeutic use
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Summary:The only effective treatment for 'failing' Kasai portoenterostomy is liver transplantation (LT). However, to maximise a patient's chances to achieve the proclaimed >95% survival with sequential surgical management, medical follow-up and treatment must be planned carefully. This includes routine fat-soluble vitamin supplementation with choleretics, aggressive nutritional support, regular ultrasonography, optimal general paediatric care, and psychological support for the family once complications arise. Careful timing of LT is of critical importance, although recent trends include earlier consideration of LT in children with biliary atresia. This management can only be offered through centralised, specialised national services. Due to its ramifications in paediatric surgery, dietetics, metabolic, social, adolescent and transplantation medicine, paediatric hepatology is a fine example of patient care that is genuinely multidisciplinary.
ISSN:0256-9574
DOI:10.7196/SAMJ.6129