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Abstract(s)
A atresia biliar é uma doença que se manifesta nos primeiros meses de vida, através de
obstrução ascendente da árvore biliar, causando colestase severa e deterioração
rapidamente progressiva com cirrose. É a causa mais frequente de colestase neonatal,
traduzindo-se clinicamente por icterícia colestática, hepatomegalia, acolia e colúria
persistentes.
Com a progressão da doença existe acometimento de toda a árvore biliar, desencadeando
cirrose e insuficiência hepática, tornando a atresia biliar a causa mais comum de transplante
hepático em crianças. Ao longo dos anos, a terapêutica da atresia biliar tem tido como base
a intervenção cirúrgica, sendo que existem duas técnicas principais para a mesma: a
Portoenterostomia de Kasai, técnica tradicional e amplamente difundida e utilizada, e a sua
variante Laparoscópica, uma técnica em ascensão mais recentemente, de acordo com os
avanços tecnológicos da Medicina.
Esta tese tem como objetivo, através de uma Revisão Bibliográfica, comparar as técnicas
cirúrgicas da terapêutica da atresia biliar, de modo a identificar qual a técnica mais
adequada e com melhor prognóstico para os pacientes.
Com este trabalho foi constatado que a portoenterostomia de Kasai permanece o gold
standard para o tratamento cirúrgico da atresia biliar, mesmo com o surgimento de novas
técnicas sendo, no entanto, necessária uma uniformização dos protocolos cirúrgicos da
mesma. Dentro das novas técnicas emergentes, a técnica laparoscópica é a que apresenta
maior potencial para ser utilizada como segunda opção terapêutica em centros com os meios
necessários e cirurgiões especializados, podendo ser o próximo passo no avanço da
abordagem cirúrgica no futuro.
Biliary atresia is a disease that manifests in the first few months of life, characterized by the ascending obstruction of the biliary tree, leading to severe cholestasis and rapidly progressive deterioration with cirrhosis. It is the most common cause of neonatal cholestasis, clinically presenting with persistent cholestatic jaundice, hepatomegaly, acholic stools and choluria. As the disease progresses, the entire biliary tree is affected, resulting in cirrhosis and liver failure, making biliary atresia the most common indication for liver transplantation in children. Over the years, the treatment of biliary atresia has been primarily surgical, with two main techniques: Kasai portoenterostomy, a traditional and widely used technique, and its laparoscopic variant, a recently rising technique in accordance with technological advances in Medicine. This thesis aims to compare the surgical techniques for the treatment of biliary atresia through a Literature Review, in order to identify the most suitable technique with the best prognosis for patients. This work has concluded that Kasai portoenterostomy remains the gold standard for the surgical treatment of biliary atresia, despite the emergence of new techniques. However, there is a need for standardization of the surgical protocols for Kasai portoenterostomy. Among the emerging techniques, laparoscopic approach shows the most potential as a second therapeutic option in centers with necessary resources and specialized surgeons, potentially representing the next step in the advancement of surgical approach in the future.
Biliary atresia is a disease that manifests in the first few months of life, characterized by the ascending obstruction of the biliary tree, leading to severe cholestasis and rapidly progressive deterioration with cirrhosis. It is the most common cause of neonatal cholestasis, clinically presenting with persistent cholestatic jaundice, hepatomegaly, acholic stools and choluria. As the disease progresses, the entire biliary tree is affected, resulting in cirrhosis and liver failure, making biliary atresia the most common indication for liver transplantation in children. Over the years, the treatment of biliary atresia has been primarily surgical, with two main techniques: Kasai portoenterostomy, a traditional and widely used technique, and its laparoscopic variant, a recently rising technique in accordance with technological advances in Medicine. This thesis aims to compare the surgical techniques for the treatment of biliary atresia through a Literature Review, in order to identify the most suitable technique with the best prognosis for patients. This work has concluded that Kasai portoenterostomy remains the gold standard for the surgical treatment of biliary atresia, despite the emergence of new techniques. However, there is a need for standardization of the surgical protocols for Kasai portoenterostomy. Among the emerging techniques, laparoscopic approach shows the most potential as a second therapeutic option in centers with necessary resources and specialized surgeons, potentially representing the next step in the advancement of surgical approach in the future.
Description
Keywords
Atresia Biliar Portoenterostomia Prognóstico Tratamento Cirúrgico