Analysis of factors influencing the timing of Kasai portoenterostomy in biliary atresia and the impact of early surgery on prognosis.

PURPOSE: Early diagnosis and Kasai portoenterostomy (KPE) are crucial for improving prognosis in biliary atresia (BA) patients. This study aims to identify factors influencing the timing of KPE and to explore potential strategies for optimizing the diagnosis and treatment of BA. METHODS: Infants diagnosed with type III BA who underwent KPE were enrolled in this study. Patients were classified into Early (≤ 30 days), Middle (31-60 days), and Late (> 60 days) surgery groups based on age at KPE. Clinical information including medical history, preoperative examination data and postoperative outcomes was collected. RESULTS: 165 BA patients were included, comprising 23 in Early, 82 in Middle, and 60 in Late surgery group. The mean age at KPE has been decreasing in the past two years (50.40 ± 20.99 days, 23.33% in Early surgery group). In the Late surgery group, 48.33% patients had not had pale stools identified before referral to a specialist center. Preoperative levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and direct bilirubin were significantly lower in the Early surgery group. The Early surgery group exhibited milder liver fibrosis. The Early surgery group demonstrated significantly higher rates of jaundice clearance post-KPE (1 month: 56.52%, 2 months: 78.26%, 3 months: 91.30%) and native liver survival (90.87% at both 1 and 2 years). CONCLUSION: Delayed recognition of pale stools and multiple referrals contribute to delayed KPE. Effective screening programs and optimized diagnostic workflows require continuous promotion.