What is the optimal timing for Kasai portoenterostomy in biliary atresia, and what outcome determines success of the procedure?
- A Before 60 days of age, judged by restoration of bile flow into the Roux limb ✓
- B Before 6 months of age, judged by normalization of serum albumin
- C Any time before 1 year, judged by resolution of pruritus
- D Immediately after diagnosis regardless of age, judged by fall in alkaline phosphatase
Correct answer: A. Before 60 days of age, judged by restoration of bile flow into the Roux limb
Explanation
Kasai portoenterostomy involves dissection at the porta hepatis and a Roux-en-Y hepaticojejunostomy. Success depends on establishing bile drainage, evidenced by passage of pigmented stools and falling conjugated bilirubin. Outcomes decline steeply with age: performed before about 60 days, roughly two thirds establish good flow, whereas after 90 days results are poor and transplant becomes likely. Age at operation, not symptom duration alone, is the strongest modifiable prognostic factor.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.