Factors associated with biloma formation in biliary atresia patients after Kasai operation and outcomes of percutaneous transhepatic biliary drainage

This study aims to investigate factors associated with the development of biloma after Kasai operation, and to study the outcomes of treatment. A retrospective chart review was conducted on biliary atresia patients who underwent Kasai operation at Siriraj Hospital from 2006 to 2021. The eligible 79 patients were divided into groups with biloma (n=13) and without biloma. Clinical and laboratory data at diagnosis and postoperation were compared. The treatment outcome of biloma was studied. Finally, the overall outcomes of portoenterostomy between both groups were analyzed. Patients with biloma demonstrated a longer time to jaundice clearance (p=0.004), more frequent episodes of postoperative cholangitis (p=0.006), and higher levels of alkaline phosphatase (ALP) at 5 months post-operation (p=0.037). There was a significant decrease in bilirubin levels (p=0.028) and gamma-glutamyltransferase (GGT) (p=0.021) after biloma treatment. However, there was no significant difference in the overall outcomes of Kasai operation between the two groups. Biloma formation should be suspected in biliary atresia patients requiring longer duration to clear jaundice, having persistent ALP level and frequent episodes of cholangitis after the Kasai operation. Treatment of biloma improves liver function but it did not show a significant difference in the overall outcome of portoenterostomy.