ObjectiveTo compare the efficacy of two regimens of biliary atresia treated with Kasai-liver transplantation (LT) sequential therapy and direct primary LT. MethodsA retrospective study was conducted on pediatric patients diagnosed with biliary atresia who underwent LT and met the inclusion and exclusion criteria at the Department of Pediatric Surgery, West China Hospital, Sichuan University, from January 2018 to January 2025. The enrolled children were divided into two groups according to treatment regimens: the Kasai-LT group and the direct primary LT group. Demographic data, general clinical data, intraoperative conditions, postoperative recovery, complications, and survival rates were compared between the two groups. ResultsA total of 300 pediatric patients were enrolled, including 225 in the Kasai-LT group and 75 in the primary LT group. After propensity score matching, there were 150 patients in the Kasai-LT group and 75 in the primary LT group. In terms of surgical parameters, the Kasai-LT group had a shorter operative time (P=0.005), stay in the pediatric intensive care unit (P=0.026), and total hospital stay (P=0.015), as well as lower hospitalization costs (P=0.017). No significant differences were observed in liver function recovery on postoperative day 7 between the two groups (P>0.05). The Kasai-LT group presented lower incidences of hepatic artery complications and thoracic and abdominal infections compared with the primary LT group (P=0.023 and P=0.003, respectively). The 5-year cumulative survival rates were 94.40% for the Kasai-LT group and 88.10% for the primary LT group, while the 5-year cumulative graft survival rates were 89.30% and 86.80%, respectively. No statistically significant differences were found between the two groups for either indicator (P>0.05). ConclusionsKasai procedure for biliary atresia can effectively improve LT conditions and reduce the rate of postoperative complications. For the treatment of biliary atresia, sequential Kasai procedure combined with LT is a viable option, and individualized therapeutic regimens should also be adopted.
ObjectiveTo summarize the clinical experience of retropancreatic tunnel established by superior mesenteric vein-approach in a child with cavernous transformation of the portal vein (CTPV) during Rex bypass. MethodThe retropancreatic tunnel was created by the superior mesenteric vein-approach during Rex bypass in a child with CTPV who was admitted to our hospital in September, 2023. Clinical data were retrospectively analyzed. ResultsFor the 4-year-old male child who was diagnosed with CTPV, after the establishment of the retropancreatic tunnel by superior mesenteric vein-approach, the portal vein was quickly identified, thus simplifying the portal dissection. The operation time of Rex bypass was about 8 hours, and intraoperative blood loss was about 60 mL. After a 3-month follow-up, the child recovered well with patent bypass vessels. ConclusionThe surgical strategy proposed by our team can simplify the Rex bypass, resulting in more rapid and safe access to the vascular anastomosis site.