SOC
Surgery on Children

Surgery on Children Journal aims to publish issues related to Pediatric Surgery, Pediatric Neurosurgery, Pediatric Plastic Surgery, Pediatric Cardiovascular Surgery, Pediatric Orthopedic Surgery, Pediatric Vascular Surgery, Pediatric Gynecology and Obstetrics, Pediatric Ear Nose Throat, Ophthalmology, Pediatric Anesthesiology and Reanimation, Pediatric Urology, Pediatric Surgical Intensive Care Clinic, and other clinical surgery fields on children of the highest scientific and clinical value at an international level and accepts articles on these topics.

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Original Article
Clinical outcomes after kasai portoenterostomy in biliary atresia: role of early surgery and liver surface telangiectasia in a resource-limited setting
Abstract
Aims: Biliary atresia (BA) remains a leading cause of pediatric liver failure worldwide, with outcomes heavily influenced by the timing of intervention and healthcare resources. In low- and middle-income countries, delayed diagnosis and limited access to specialized care contribute to poorer outcomes following Kasai portoenterostomy (KPE). This study aimed to evaluate clinical outcomes and identify prognostic factors in infants undergoing KPE at a tertiary pediatric center.
Methods: This retrospective observational study included all consecutive infants with biliary atresia who underwent KPE at our center between January 2022 and December 2025. Data on demographic characteristics, preoperative biochemical parameters, intraoperative findings, and postoperative outcomes were collected. Survival and jaundice clearance were assessed at 3, 6, and 12 months. Associations between clinical variables and outcomes were analyzed using the Mann–Whitney U test, the Chi-square test, or Fisher’s exact test, with p < 0.05 considered statistically significant.
Results: A total of 52 infants were included, with a median age at operation of 71 days. Liver surface telangiectasia was present in 63.5% of patients. The 30-day mortality was 7.7%, and survival rates at 3 months, 6 months, and 1 year were 65.4%, 51.9%, and 48.1%, respectively. Jaundice clearance at 6 months was achieved in 34.6% of patients. Younger age at operation was significantly associated with jaundice clearance (median 62 vs 72 days, p = 0.046). Preoperative direct bilirubin was significantly higher among non-survivors (p = 0.028). Liver surface telangiectasia showed a trend toward poorer jaundice clearance (p = 0.055). Kaplan–Meier analysis demonstrated a progressive decline in survival, particularly within the early postoperative period.
Conclusion: Outcomes of biliary atresia following KPE remain suboptimal in this setting, largely due to delayed presentation and advanced disease at surgery. Early surgical intervention is the most important modifiable factor associated with improved bile drainage, while elevated direct bilirubin and liver surface telangiectasia may indicate poorer prognosis. Strengthening early diagnosis and referral pathways is essential to improving outcomes in resource-limited settings.

Keywords : Biliary atresia, kasai portoenterostomy, jaundice clearance, survival analysis, liver fibrosis, pediatric surgery

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Article available in :
Volume 3, Issue 2, 2026
Page : 38-42
https://doi.org/10.51271/SOC-0066
Article Information
Received : 01 Mar 2026
Accepted : 04 Nis 2026
Published : 27 Nis 2026
Corresponding Author :

Samiul Hasan: Department of Pediatric Surgery, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh

[email protected]
Citation : Hasan S, Biva UFK, Mahmud R, Islam N, Mitul AR. Clinical outcomes after Kasai portoenterostomy in biliary atresia: role of early surgery and liver surface telangiectasia in a resource-limited setting. Surg Child. 2026;3(2):38-42. doi:10.51271/SOC-0066

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