Outcomes of revised portoenterostomy for postoperative bile lakes in patients with biliary atresia

Objectives Kasai portoenterostomy (KPE) is the primary treatment for biliary atresia (BA). However, postoperative complications such as cholangitis with bile lake formation frequently lead to liver failure. This study aimed to evaluate the therapeutic efficacy and significance of revision portoenterostomy in patients with bile lakes at the porta hepatis following KPE. Methods A retrospective analysis of patients with BA who underwent revision portoenterostomy from January 2011 to December 2021 was conducted. Patient data, including laboratory tests, imaging findings, and follow-up records, were comprehensively reviewed. The jaundice clearance rate and autologous liver survival rate were assessed using the Kaplan–Meier method. The Cox proportional hazards model was employed to identify factors influencing revision portoenterostomy outcomes. Results Twenty patients with cholangitis and bile lakes underwent revision portoenterostomy. Sixteen patients (80 %) achieved jaundice clearance, and 14 (60 %) attained autologous liver survival, resulting in an overall survival rate of 90 %. All patients with refractory cholangitis preoperatively showed improvement following revision portoenterostomy. Additionally, the revision portoenterostomy procedure did not lead to increased blood loss or extended operation times in subsequent liver transplants. Conclusions Revision portoenterostomy for patients with bile lakes effectively alleviates intractable cholangitis and can delay or eliminate the necessity for liver transplantation.