OBJECTIVE : Biliary atresia (BA) can cause liver fibrosis. Kasai portoenterostomy (KPE) can restore bile flow and improve the survival of native liver, unfortunately >50% of children still on the liver transplant waiting list. Age at surgery, Total serum bilirubin, direct bilirubin known to be factors that affect the outcome of KPE. Post-KPE results were evaluated by jaundice clearance, which results in decrease in liver fibrosis. The objective of this study was to analyze changes in total serum bilirubin and direct bilirubin within 7 days after KPE and the outcome.
METHOD : Retrospective review of  consecutive Kasai procedure for biliary atresia was taken from January 2014-April 2019. Total serum bilirubin and direct bilirubin were recorded before and 7 days after Kasai procedure. The Statistical Package for Social Sciences 21.0 using paired t-test analysis for bilirubin serum before and after Kasai, logistic regression test was used to analyze the outcome, with p value < 0.05 regarded as statistically significant.
RESULT : There were 23 BA patients undergoing Kasai procedure (M:F=7:16). Age at Kasai >90 days were 22 patients (95.65%). The average age at the Kasai procedure was 150.83  days. The average Bilirubin total and bilirubin direct before Kasai were 11.87 and 9.32, while after the Kasai were 13.65 and 10.33 respectively. Paired t-test analysis for Total serum Bilirubin before and after Kasai increased 1.78 (p=0.033), while direct bilirubin increases by 1.01 (p=0.066). Regression analysis showed that Total serum bilirubin and direct bilirubin after kasai were not significant with outcomes (OR=1.21, 95%CI 0.96-1.52, p=0.11) and (OR=1.28, 95%CI 0.92-1.79, p=0.15). The average survival age after the Kasai procedure was 78.30 days.
CONCLUSION : There was significant difference in the increase of Total serum bilirubin before and after the Kasai procedure, but no significant correlation with outcome of the patient.