Introduction: Biliary atresia implies high risk of mortality ifnot diagnosed and treated early. We undertook this study toassess the prognostic factors affecting the outcome ofKasai surgery.Methods: A retrospective clinical study was conductedamong 58 patients from Hospital Sultanah Bahiyah AlorSetar. Data were analysed with logistic regression analysisusing SPSS. Factors studied included age during surgery,bile duct diameter at the porta hepatic, race of patient,preoperative total bilirubin level and cholangitis. Thesefactors were analysed to determine its significance as aprognostic factor affecting the outcome of Kasai surgery.Results: Older age group above 56 days of life, bile ductdiameter at porta hepatis measuring <50µm, pre-operativetotal bilirubin >10mg% and cholangitis were found to bepoor prognostic factors from univariate regression analysis.Variables having p value<0.025 were analysed using themultivariable regression analysis. Only age of patient anddiameter of bile duct at the porta hepatis were eligible forthis analysis. The final analysis showed that age 57 days oflife and above (adjusted odd's ratio (aOR) = 9.412, p value =0.042, 95% confidence interval (95%CI) = 1.079 to 82.104) andbile duct diameter <50µm (aOR = 13.812, p value = 0.016,95%CI = 1.616 to 118.042) were significant factors affectingthe outcome.Conclusion: In conclusion, age of patient 56 days of life andyounger and diameter of bile duct at porta hepatis ≥50µmgave a significantly better outcome after Kasai surgery.

Renal replacement therapy in Malaysia has changed dramatically. In 1980 there were only 59 patients on dialysis. Since then the number of patients has increased exponentially from 4,540 in 1998 to almost 15,000 in 20061. Autogenous Arteriovenous Fistula (AVF) provides an excellent long term hemodialysis access with low rates of infection, thrombosis and is cost effective. Hospital Sultanah Bahiyah is a tertiary hospital situated in the northern region of Peninsular Malaysia. Vascular Access creation is one of the main services provided by our surgical unit; with an average of 100 patients seen in the vascular access clinic per month. The number of AVF operations has increased from 30 cases in 2001 to 328 in 2007. The reported rates of Primary Fistula Failure (fistula fail to mature) varies from 8% to 53%2,4. Immature fistulae will lead to prolonged dependence on dialysis catheters. This phenomenon is well known to be associated with the risk of infective complications, central venous thrombosis or stenosis and patients’ inconvenience. Numerous studies have reported the predictors of successful fistulae, but are varied in their design, definitions, end points and clinical factors considered 2,3 Preoperative imaging also has been proposed, but their widespread use is generally limited in most of the centres4. Knowing the risk factors for failure will help the surgeon to take the necessary precautions and preventive measures more effectively. The information may help to stratify the patients into various risk groups based on their likelihood to develop fistula failure. Thus, the main objective of this study was to identify clinical risk factors that are related to Failure to Mature (FTM) of autogenous AVF.

Alimentary tract duplication is a rare congenital anomaly which may involve any part of the alimentary tract extending from stomach to rectum. Clinical presentation may mimic an inflamed appendix as described in this case. A 9-year-old boy with a clinical diagnosis of perforated appendix was noted to have a normal appendix intra-operatively. On further search for an underlying pathology, a gangrenous ileal duplication was discovered. En-bloc resection with primary bowel anastomosis was done. Histopathology report revealed a gangrenous small bowel duplication. We discuss the preoperative diagnostic dilemma and management options in approaching this rare entity.
Gangrene ; Ileum