Browsing by Author "Ginström, Daniel"

Objectives: Cholangitis and bile lakes are incompletely understood complications after portoen-terostomy (PE). We investigated relationships between recurrent cholangitis, bile lakes, and clinical outcomes as well as surgical management of bile lakes. Methods: In this retrospective observational single institution study medical records and imag-ing studies of all patients who had undergone PE for biliary atresia during 1987 to 2016 (N=61) were reviewed. We related occurrence of cholangitis episodes with the presence of in-trahepatic bile lakes, patient characteristics, and PE outcomes. Risk factors for recurrent cholan-gitis and bile lakes, and management of bile lakes were analyzed. Results: Despite routine antibiotic prophylaxis median of 3.0 cholangitis episodes (0.75 epi-sodes/year) occurred in 48 (79%) patients. Intrahepatic bile lakes were discovered in 8 (13%) patients by 16 months after PE. Overall, 54% had survived with their native liver at median age of 7.3 years and 28 (46%) patients had >1 cholangitis episodes/year. Number and frequency of cholangitis episodes were >5 times higher among patients with bile lakes (P<0.001). Six pa-tients underwent Roux-en-Y bile lake- jejunostomy, resulting in regression/disappearance of bile lakes and normalization of serum bilirubin in 5 with reduction of median yearly cholangitis rate from 8.8 to 1.1 (P=0.028) and native liver survival of 6.3 (range, 1.3–17) years after the operation. Conclusions: Bile lakes are a significant risk factor for recurrent cholangitis after PE and effi-ciently treated by operative intestinal drainage providing prolonged jaundice-free native liver survival. Bile lakes should be actively screened among patients presenting with recurrent chol-angitis after PE. (248 words)