Utility of hospital admission for pediatric intussusceptions

Purpose

The standard practice in pediatric patients diagnosed with intussusception has been reduction via enema and admission for a period of nil per os and observation. Little data exists to support this practice. The objective of this study was to examine whether post-reduction admission to hospital is required.

Methods

A retrospective chart review was performed on all patients aged 0–18 years old with intussusception over a span of 20 years. Study included children treated for intussusception on first encounter with enema and subsequently admitted for observation. Study excluded those readmitted for recurrence after 48 h, patients whose intussusception did not reduce on first try, those lost to follow-up, and those who went to the operating room. Early recurrence was defined as recurrence within 48 h post-reduction.

Results

Out of 171 patients admitted, only one experienced an early recurrence (0.6 %). Median length of stay for all patients was 2 days. Average cost incurred per day for intussusception admission was $404.

Conclusion

Intussusception in a child that is successfully reduced via enema has a low recurrence rate and is usually followed by prompt resolution of symptoms. An abbreviated period of observation in the emergency department post-reduction may result in healthcare savings.

     

Risk factors for short-term recurrent intussusception and reduction failure after ultrasound-guided saline enema

Objective

To investigate the safety and effectiveness of ultrasound-guided saline enema to treat intussusception and to analyze the risk factors affecting short-term recurrence and reduction failure.

Materials and methods

We selected patients who had undergone intussusception reduction via ultrasound-guided saline enema from January 2010 to December 2017. The overall success rate, overall pathologic intussusception rate, and pathologic intussusception rate were calculated in each group. All the patients were divided into two groups: the successfully reduced group and the failed reduction group. Then, the successfully reduced patients were divided into two groups: the short-term recurrence group and the short-term non-recurrence group. The differences between each of the two sets of groups were analyzed, and the risk factors affecting short-term recurrence and failure of intussusception were analyzed.

Results

During the 8-year study period, a total of 1793 patients with intussusception were treated with ultrasound-guided saline enema reduction in our hospital. Among these patients, 1743 (97.2%) experienced successful reduction, 29 (1.6%) had pathologic intussusception, and 1 experienced perforation. After applying the univariate analysis and logistic regressive multivariate analysis, we found that age above 2 years and the absence of fever were risk factors for the early recurrence of intussusception. Pathologic intussusception was a risk factor for reduction failure.

Conclusion

The overall success rate of ultrasound-guided saline enemas was 97.2%, and the pathologic intussusception rate was 1.6%. Age above 2 years and the absence of fever were risk factors for short-term recurrence, and pathologic intussusception was a risk factor for the failure of reduction.

     

Use of ultrasound in diagnosing postoperative small-bowel intussusception in pediatric surgical oncology patients: a single-center retrospective review

Background

Postoperative intussusception can be a complication of abdominal surgery and often poses a diagnostic dilemma.

Objective

The purpose of this study was to evaluate the utility of ultrasonography in the diagnosis of intussusception in children who had recently undergone resection of a primary solid tumor.

Materials and methods

We performed a retrospective review of all pediatric surgical oncology patients undergoing laparotomy for excision of an abdominal tumor at our institution from 1995 to 2015. We reviewed those with documented postoperative intussusception. In addition we searched the radiology database for all ultrasound examinations requested to rule out postoperative intussusception during our study interval. We analyzed demographics, primary diagnosis, surgical procedure, presentation, diagnostic investigations and definitive treatment.

Results

At our institution 852 laparotomies for abdominal tumor resection were performed during the study period, resulting in 10 postoperative intussusceptions (1.2% of cases), of which half were following neuroblastoma resection and the other half following nephrectomy for Wilms tumor. Postoperative intussusception was suspected if the patient had increasing nasogastric output, abdominal distension or feeding intolerance. Ultrasound was used to diagnose intussusception in 9/10 cases, on postoperative day 6 (standard deviation [SD] 5.6 days) on average, with a sensitivity of 89% (8/9; one false negative; 95% confidence interval [CI] 0.52, 1.00) and a specificity of 100% (no false positives; 95% CI 0.96, 1.00).

Conclusion

Ultrasound was highly accurate in diagnosing postoperative intussusception in children who underwent resection of retroperitoneal tumors.

     

Clinical characteristics of intussusception secondary to pathologic lead points in children: a single-center experience with 65 cases

Objective

Intussusception secondary to pathologic lead points (PLPs) is a challenging condition for pediatric surgeons, and few studies have been published on this subject. The aim of this study was to review and analyze clinical data on the diagnosis and management of intussusception secondary to PLPs in children.

Methods

Between 2002 and 2016, a total of 65 pediatric patients with a diagnosis of intussusception secondary to PLPs were retrospectively reviewed.

Results

The series comprised 47 males and 18 females. The average age of the patients was 4.9 years old. All patients had typical clinical manifestations, and intussusception was proven by ultrasound. Fifty-one patients had recurrent intussusception, of whom 21 had one, 14 had two, 10 had three, and 6 had more than three. There were 20 episodes of recurrence within 24 h (39.2%), 15 episodes were found between 24 and 72 h (29.4%), and the remaining 31.4% (16/51) of recurrences occurred after 72 h. All patients received surgical intussusception reduction. Meanwhile, enterectomy was the procedure of choice in 55 patients, polypectomy in 5 patients, and cystectomy in 3 patients. The types of intussusception secondary to PLPs included small intestinal (n = 25), ileocolic (n = 19), ileocecal (n = 11), ileo–ileocolic (n = 9) and cecalcolic (n = 1). The types of PLPs included Meckel diverticulum (n = 32), intestinal duplication (n = 14), benign polyps (n = 5), malignant lymphoma (n = 4), Peutz–Jeghers syndrome (n = 3), mesenteric cyst (n = 3), intestinal wall hematoma of hemophilia (n = 2), allergic purpura (n = 1), and hamartoma (n = 1). All patients recovered well with no relapse during follow-up, except for one patient who had an intestinal obstruction from adhesions that occurred approximately 3 months after discharge and who was curable after conservative treatment.

Conclusions

Intussusception secondary to PLPs tends to exhibit recurrence. There are various types of intussusception secondary to PLPs. It is necessary to improve auxiliary examinations to identify the etiology and avoid intraoperative omission. Surgical reduction of intussusception secondary to PLPs is the preferred clinical management.

     

Risk of Intussusception with Rotavirus Vaccine

Objective

To study the case series for intussusception associated with the vaccination of rotavirus vaccine in children.

Methods

The study of spontaneous adverse event monitoring such as intussusception due to rotavirus vaccine was carried out from the year 2011 through 2015. The individual case safety reports (ICSRs) of this event were collated, assessed and recorded as per the requirement of Suspected Adverse Drug Reactions Reporting form of Pharmacovigilance Programme of India (PvPI).

Results

In the present study, 10 ICSRs of intussussception due to rotavirus vaccine were reported to PvPI. Of which 3 ICSRs were found to be causal relationship with rotavirus vaccine, as evidenced by the adequate information provided in ICSRs.

Conclusions

Since intussusception, the emerging safety as one of the important safety concern, healthcare professionals are advised to monitor and report to the concerned authority for appropriate action.

     

Long-term outcome and need of re-operation in gastro-esophageal reflux surgery in children

Background

Fundoplication is considered a mainstay in the treatment of gastro-esophageal reflux. However, the literature reports significant recurrences and limited data on long-term outcome.

Aims

To evaluate our long-term outcomes of antireflux surgery in children and to assess the results of redo surgery.

Methods

We retrospectively analyzed all patients who underwent Nissen fundoplication in 8 consecutive years. Reiterative surgery was indicated only in case of symptoms and anatomical alterations. A follow-up study was carried out to analyzed outcome and patients’ Visick score assessed parents’ perspective.

Results

Overall 162 children were included for 179 procedures in total. Median age at first intervention was 43 months. Comorbidities were 119 (73 %), particularly neurological impairments (73 %). Redo surgery is equal to 14 % (25/179). Comorbidities were risk factors to Nissen failure (p = 0.04), especially children suffering neurological impairment with seizures (p = 0.034). Follow-up datasets were obtained for 111/162 = 69 % (median time: 51 months). Parents’ perspectives were excellent or good in 85 %.

Conclusions

A significant positive impact of redo Nissen intervention on the patient’s outcome was highlighted; antireflux surgery is useful and advantageous in children and their caregivers. Children with neurological impairment affected by seizures represent significant risk factors.

     

5 years after an ACE: what happens then?

Purpose

Antegrade continence enema (ACE) revolutionised the lives of children with chronic constipation and soiling. Parents often ask how long the ACE will be required. We looked at our patients 5 years after ACE formation to answer the question.

Methods

We reviewed clinical notes of all patients undergoing ACE procedure during January 1990 to December 2010. Only patients with >5 years follow-up were included. Data are given as median (range).

Results

133 patients were included with >5 years of follow-up. Primary pathology was anorectal anomaly (ARA) 64 (48 %); spinal dysraphism (SD) 40 (30 %); functional constipation (FC) 14 (10 %); Hirschsprung’s Disease (HD) 10 (8 %) and others 5 (4 %). Median follow-up was 7 years (5–17 years). Overall 74 % still use their ACE; whilst 26 % no longer access their stoma, of whom 47 % recovered normal colonic function. 50 % of HD patient recover colonic function. FC has the highest failure rate at 21 %.

Conclusions

Overall 86 % achieved excellent clinical outcome with 74 % of patient still using their ACE at 5 years. HD has the highest recovery rate of 50 %. FC has a more unreliable clinical outcome with 21 % recovered colonic function and 21 % failed. Outcome varied dependent on the background diagnosis.

     

Assessing colonic anatomy normal values based on air contrast enemas in children younger than 6 years

Background

Contrast enemas with barium or water-soluble contrast agents are sometimes performed in children with severe intractable constipation to identify anatomical abnormalities. However there are no clear definitions for normal colonic size or abnormalities such as colonic dilation or sigmoid redundancy in children.

Objective

To describe characteristics of colonic anatomy on air contrast enemas in children without constipation to provide normal values for colonic size ratios in children.

Materials and methods

We performed a retrospective chart review of children aged 0–5 years who had undergone air contrast enemas for intussusception. The primary outcome measures were the ratios of the diameters and lengths of predetermined colonic segments (lengths of rectosigmoid and descending colon; diameters of rectum, sigmoid, descending colon, transverse colon and ascending colon) in relation to the L2 vertebral body width.

Results

We included 119 children (median age 2.0 years, range 0–5 years, 68% boys). Colonic segment length ratios did not change significantly with age, although the differences for the rectosigmoid/L2 ratio were borderline significant (P?=?0.05). The ratios that involved the rectal and ascending colon diameters increased significantly with age, while diameter ratios involving the other colonic segments did not. Differences by gender and race were not significant.

Conclusion

These data can be used for reference purposes in young children undergoing contrast studies of the colon.

     

Post-resection outcomes for pediatric ovarian neoplasm: is ovarian-preserving surgery a good option?

Purpose

Pediatric surgeons often care for children with ovarian tumors. Few studies report long-term outcomes for these patients. This study characterizes intermediate-term results for patients who underwent surgical resection of ovarian neoplasms as children.

Methods

Patients who underwent surgery for ovarian neoplasms at a children’s hospital were identified. They were invited to participate in a telephone-based survey assessing post-surgical recurrence, dysmenorrhea, quality of life, and fertility.

Results

188 patients were identified; 79 met criteria. 31 patients had ovarian-sparing tumor resection; 48 had oophorectomy; five had recurrences. 56 were successfully interviewed at a median follow-up of 4.6 years. Dysmenorrhea rates of 52 and 78 % were reported (p = 0.07), respectively. Two patients suffered from infertility. Quality of life was generally reported as good.

Conclusion

Intermediate outcomes are good for patients who underwent ovarian-sparing tumor resection or oophorectomy for pediatric ovarian tumors. Additional long-term monitoring would be beneficial to better assess fertility and dysmenorrhea outcomes.

     

Pathological changes of interstitial cells of Cajal and ganglion cells in the segment of resected bowel in Hirschsprung’s disease

Objectives

This study was conducted to investigate the pathological changes which occur in interstitial cells of Cajal (ICCs) and ganglion cells found in segments of resected bowel obtained from patients with Hirschsprung’s disease (HD), as well as to explore the benefits of using a contrast enema (CE) with 24-h delayed X-ray films to predict the length of resected bowel.

Methods

We performed a retrospective analysis of 58 children with HD who had undergone the pull-through procedure. After each operation, the ICCs and ganglion cells present in the proximal ends of the barium residue (Level A) and resected proximal bowel segment (Level B) were analyzed using immunohistochemical staining methods. Each patient was followed up for 1 year to record their stool frequency, defecation control ability, and post-surgical complications which may have occurred.

Results

Immunohistochemical staining detected fewer ICCs in Level A than in Level B (p < 0.05). However, the density of ganglion cells in the two levels was not significantly different (p > 0.05). One patient had anastomotic stricture, and five patients suffered from enterocolitis.

Conclusions

The density of ICCs was significantly lower in the bowel segments that displayed barium retention. A CE may be a valuable tool for predicting the length of bowel resection in patients with HD.

     

Sternocostal slipping rib syndrome

Purpose

Classical slipping rib syndrome (SRS) can be subclassified based on anatomical location. We describe our experience with three patients suffering from symptomatic sternocostal slipping rib syndrome (SCSRS), a much less common variant of SRS.

Methods

This was a retrospective review of patients with SRS from 1988 to 2016. Described is our experience.

Results

Of 44 patients identified with SRS, three patients underwent operations for SCSRS variant. All three had significant pain and point tenderness at the sternocostal junction, and all experienced a popping sensation localized to this area. The mean age at onset was 14.3 years and mean time to diagnosis was 1.3 years. All patients experienced total resolution of symptoms following localized excision of the offending cartilage.

Conclusions

A high index of suspicion based on history and physical examination are key to the early diagnosis of SCSRS. Excision of the symptomatic cartilage is effective for treatment.

     

Functional exercise capacity and lung function in patients undergoing an early rehabilitation program after the Nuss procedure: a randomized controlled trial

Purpose

The aim of this study was to compare the functional exercise capacity and the lung function among patients undergoing early rehabilitation with those submitted to the conventional care after pectus excavatum repair using the Nuss procedure.

Method

Patients were randomly allocated to the early rehabilitation group (ERG) who started rehabilitation after surgery and the group of the conventional care (CG) received routine care of the institution. They were evaluated before surgery (preoperative) and in hospital discharge day (postoperative).

Results

Forty patients were evaluated, twenty in each group. All patients presented a significant reduction in FVC, FEV1, and PEF in the postoperative period, there was no statistically significant difference between groups. There was significant different in postoperative functional exercise capacity between the ERG and CG (506.26 ± 66.54 vs 431.11 ± 75.61, p = 0.02) and the difference between distance walked in the preoperative and postoperative period was lower in the ERC than in the CG (76.57 ± 49.41 vs 166.82 ± 70.13, p < 0.001).

Conclusion

Patients undergoing the early rehabilitation after the Nuss procedure presented a better postoperative functional exercise capacity in hospital discharge day compared with patients in the conventional group, with no difference in lung function between groups.

     

Ultrasound-guided core needle biopsy in the diagnosis of neuroblastic tumors in children: a retrospective study on 83 cases

Aim

Ultrasound-guided biopsy technique with the large-core needle has widely been applied in the diagnosis of adult abdominopelvic cavity, thyroid, and neck tumors. There are few reports on ultrasound-guided biopsy using large-core needle in pediatric abdominopelvic cavity tumors. This study was to evaluate the ultrasound features and the diagnostic value of ultrasound-guided core needle biopsy for pediatric neuroblastic tumors.

Methods

The pediatric patients with neuroblastic tumor that underwent ultrasound examination and ultrasound-guided core needle biopsy from January 2009 to November 2015 were reviewed. A minimum of two cores in each case was obtained. The biopsy results were confirmed by subsequent surgical histopathology. The ultrasound features and the diagnostic accuracy of ultrasound-guided core needle biopsy were evaluated.

Results

Eighty-three patients were enrolled into the study. Conventional ultrasound examination showed irregular hypoechoic or mixed echo masses and calcification and liquefied necrosis. The diagnostic accuracy of ultrasound-guided core needle biopsy was 96.4% (80/83). Three cases were misdiagnosed because of inadequate tissue sample. No serious complication, infection, or needle track seeding occurred.

Conclusions

Ultrasound-guided core needle biopsy seems to be an accurate, minimally invasive, and safe diagnostic method of pediatric neuroblastic tumor.

     

The value of contrast studies in the evaluation of bowel strictures after necrotising enterocolitis

Purpose

Strictures of the bowel are a frequent complication post-necrotising enterocolitis (NEC). Contrast studies are routinely performed prior to stoma closure following NEC. The aim of this study was to evaluate the ability of these studies to detect strictures and also directly compare them to operative and histological findings.

Methods

Two hundred and fourteen neonates who had a diagnosis of NEC (Bell stage 2 or greater) in a single unit (2007–2011) were analysed. Their case notes, radiology, and histology were reviewed.

Results

One hundred and sixteen neonates underwent an emergency laparotomy and 77 had stomas fashioned. Sixty-six patients had a contrast study prior to stoma closure (distal loopogram 18, contrast enema 37, both studies 11). Colonic strictures were reported in 18 patients and small bowel strictures were reported in two patients. Fourteen of these colonic strictures were confirmed at operation and on histology but three colonic strictures were missed on contrast studies; one patient had had both contrast studies and the other two only a distal loopogram. Two small bowel strictures reported were confirmed and an additional small bowel stricture missed on distal loopogram was also detected at the time of operation. The incidence of post-op strictures was 19 out of 68 patients (27.9 %) and 16 (84.2 %) of these strictures were found in the colon. Contrast enemas had a much higher sensitivity for detecting post-NEC colonic strictures than distal loopograms; 93 versus 50 %, respectively; however, they are more likely to give a false positive result and therefore their specificity is lower; 88 versus 95 %, respectively.

Conclusion

Colon is the commonest site for post-NEC stricture and contrast enema is the study of choice for detecting these strictures prior to stoma closure.

     

Management of congenital tracheal stenosis in the neonatal period

Purpose

Few reports have focused on the management of congenital tracheal stenosis (CTS) in the neonatal period. The aim of this study was to determine appropriate management strategies for CTS in the neonatal period.

Methods

The medical records of eight neonatal patients with CTS at a single institution between January 2007 and December 2016 were retrospectively reviewed.

Results

Three patients with frequent ventilatory insufficiency despite assisted ventilation underwent surgical intervention (balloon tracheoplasty: n = 1, slide tracheoplasty: n = 2). Ventilatory insufficiency improved after surgery in all three patients. One patient who underwent slide tracheoplasty died due to non-airway-related causes. Observation or conservative management was performed in five patients with minimal respiratory symptoms or stable ventilation under assisted ventilation. All five patients were safely managed non-operatively in the neonatal period.

Conclusion

Depending on the severity of ventilatory insufficiency, there are two management strategies for CTS in the neonatal period. Surgical intervention, such as balloon tracheoplasty or slide tracheoplasty, is indicated for patients with unstable ventilatory status despite assisted ventilation. Observation or conservative management is a more suitable option for neonates with stable ventilation.

     

Dose optimisation for intraoperative cone-beam flat-detector CT in paediatric spinal surgery

Background

During surgery for spinal deformities, accurate placement of pedicle screws may be guided by intraoperative cone-beam flat-detector CT.

Objective

The purpose of this study was to identify appropriate paediatric imaging protocols aiming to reduce the radiation dose in line with the ALARA principle.

Materials and methods

Using O-arm® (Medtronic, Inc.), three paediatric phantoms were employed to measure CTDI_w doses with default and lowered exposure settings. Images from 126 scans were evaluated by two spinal surgeons and scores were compared (Kappa statistics). Effective doses were calculated. The recommended new low-dose 3-D spine protocols were then used in 15 children.

Results

The lowest acceptable exposure as judged by image quality for intraoperative use was 70 kVp/40 mAs, 70 kVp/80 mAs and 80 kVp/40 mAs for the 1-, 5- and 12-year-old-equivalent phantoms respectively (kappa = 0,70). Optimised dose settings reduced CTDI_w doses 89–93%. The effective dose was 0.5 mSv (91–94,5% reduction). The optimised protocols were used clinically without problems.

Conclusions

Radiation doses for intraoperative 3-D CT using a cone-beam flat-detector scanner could be reduced at least 89% compared to manufacturer settings and still be used to safely navigate pedicle screws.

     

Primary sigmoidectomy and appendicostomy for chronic idiopathic constipation

Purpose

To present our experience in patients with chronic idiopathic constipation complicated by megarectosigmoid and fecal incontinence who underwent a primary sigmoidectomy and appendicostomy.

Methods

We reviewed eight patients referred to the Colorectal Center from 2014 to 2016 with chronic idiopathic constipation and undergoing a sigmoidectomy and appendicostomy. We analyzed the previous medical treatment, indications for the surgical procedure, and outcomes.

Results

Age at operation was 5–19 years. Time with constipation was 4–15 years. All patients received multiple laxatives, mainly polyethylene glycol, and all had severe social problems. Four patients have autism. The indication for surgery was an unsuccessful laxative trial, refusal to continue with rectal enemas or both, and social fear of continued fecal incontinence. Post-operatively, all patients were having daily bowel movements without fecal accidents.

Conclusion

Selected patients with chronic idiopathic constipation complicated by megarectosigmoid and fecal incontinence can obtain great benefit from primary sigmoidectomy and appendicostomy.

     

Hypertension and prehypertension among adolescents in secondary schools in Enugu,South East Nigeria

Background

Hypertension is a prevalent cardiovascular disease risk factor among blacks and adolescent hypertension can progress into adulthood.

Objective

To determine the prevalence of hypertension and prehypertension among secondary school adolescents in Enugu South East Nigeria.

Methodology

A study of 2694 adolescents aged 10-18 years in Enugu metropolis was carried out. Socio-demographic profile anthropometric and blood pressure readings were obtained. Derived measurements such as Prehypertension, hypertension and BMI were obtained.

Results

The results showed that the mean systolic blood pressure and diastolic blood pressure for males were 106.66+ 11.80 mmHg and 70.25 + 7.34 mmHg respectively. The mean SBP and DBP for females were 109.83+ 11.66 mmHg and 72.23 + 8.26 mmHg respectively (p < 0.01). Blood pressure was found to increase with age. Prevalence of hypertension and prehypertension was 5.4% and 17.3% respectively with a higher rate in females (6.9%) than males (3.8%). Prevalence of prehypertension among males and females were 14.3% and 20.1% respectively. The prevalence of obesity was 1.9%.

Conclusion

Modifiable risk factors exist among adolescents. Early lifestyle modification and a strengthened school health are recommended.

     

Steroid pulse therapy prevents restenosis following balloon dilatation for esophageal stricture

Purpose

This study aimed to evaluate the effectiveness of intravenous steroid pulse therapy following balloon dilatation for esophageal stenosis and stricture in children.

Methods

The study enrolled six children, including three with congenital esophageal stenosis and three with anastomotic strictures after surgery for esophageal atresia, all of whom were treated by balloon dilatation combined with high-dose intravenous methylprednisolone pulse therapy. Methylprednisolone was injected intravenously at a dose of 20 mg/kg/day for 2 days, starting from the day of dilatation, followed by 10 mg/kg/day for 2 days, for a total of 4 days.

Results

Esophageal stricture recurred in all three patients with congenital esophageal stenosis despite repeated balloon dilatation without methylprednisolone. However, the symptoms of dysphagia improved and did not recur after systemic steroid pulse therapy following balloon dilatation. Symptoms also resolved in all three patients with anastomotic strictures following balloon dilatation with systemic steroid pulse therapy. All six patients remained asymptomatic after 6–21 months follow-up, with no complications.

Conclusion

Intravenous methylprednisolone pulse therapy following balloon dilatation is safe and effective for the treatment of esophageal stenosis and strictures in children.

     

Analysis of the prognostic factors of long-term native liver survival in survivors of biliary atresia

Purpose

Long-term survivors of biliary atresia (BA) sometimes experience liver dysfunction. We evaluated the prognostic factors for long-term native liver survival (NLS) in BA patients after the Kasai procedure.

Methods

This study included 67 patients with jaundice disappearance after the Kasai procedure performed between 1972 and 1995, and NLS for over 10 years. We retrospectively evaluated the clinical parameters, including the type of BA, age at the Kasai procedure, medical conditions, and treatments. The adjusted odds ratios (aOR) were obtained for 20-year NLS using logistic regression analysis.

Results

The median age of the patients at the Kasai procedure was 63 days. Of the 67 study patients, 62 patients (92.5 %) had jaundice-free NLS at the age of 20 years, 4 patients died before the age of 20 years from liver failure, and 1 patient underwent living related liver transplantation. The presence of gastro-esophageal varices requiring endoscopic injection sclerotherapy was a significant factor (aOR 33.8; p = 0.0033), while hypersplenism and cholangitis were not identified as significant factors.

Conclusions

The existence of symptomatic portal hypertension would influence long-term NLS in BA patients after the Kasai procedure. In such patients, accurate evaluation of hepatic function and adequate treatment for sequelae are needed.