Anti-Reflux Valve Procedure in Recurrent Ascending Cholangitis Following Kasai Portoenterotomy

Abstract

Ascending cholangitis (AC) is the commonest and most serious complication following Kasai portoenterostomy (KPE) that significantly affects the long-term outcome of biliary atresia (BA). The role of anti-reflux valve (ARV) construction in preventing bile reflux into the Roux limb thereby reducing the risk of AC is debated in the literature. In this report we describe two infants who experienced AC within 1 month of KPE for BA. Blood cultures grew multi-drug-resistant organisms and imaging studies revealed bile lake formation. Both underwent the ARV construction to address persistent AC. One patient showed significant clinical improvement with no further episodes of AC over a year, while the other child rapidly deteriorated with the disease progressing to liver failure and death. While adjunctive therapies like ursodeoxycholic acid and prophylactic antibiotics are beneficial, ARV appears to be a promising option in reducing bile reflux and recurrent AC, thus prolonging the longevity of the native liver in BA.