World Journal of Surgery

, Volume 9, Issue 2, pp 285–293

Progress in the treatment of biliary atresia

  • Ryoji Ohi
  • Masahiro Hanamatsu
  • Izumi Mochizuki
  • Tsuneo Chiba
  • Morio Kasai
Progress Symposium—Progress in Pediatric Surgery

Abstract

Although the surgical results of biliary atresia have markedly improved following the introduction of hepatic portoenterostomy, further improvement is necessary. In a 31-year period, from 1953 through 1983, we performed corrective surgery on 214 patients. In the first 18 years the disease was successfully treated in only 13% of 96 patients. In the next 7 years (1971 to 1977), jaundice was cleared in 55% of 65 patients, now 29 patients are alive without jaundice. In the last 6 years, the jaundice was cleared in 66% of 53 patients; more than 50% of patients are now without jaundice. Retrospective analysis revealed several important factors contributing to the improvement of operative results: (1) early diagnosis and operation, (b) precise dissection and adequate transection of the bile duct remnant, (c) progress in the postoperative management, (d) prevention of postoperative cholangitis, and (e) early reoperation whenever necessary. Corrective surgery performed within 60 days after birth can achieve sufficient bile drainage to normalize serum bilirubin level in more than 80% of the patients.

Résumé

Bien que les résultats de la chirurgie pour atrésie biliaire se soient considérablement améliorés depuis la mise en pratique de la portoentérostomie hépatique, des progrès restent à accomplir. De 1953 à 1983, soit pendant 31 ans, nous avons réalisé ce type d'intervention chez 214 malades. Au cours des 18 premières années le taux de succès concernant 98 sujets n'a atteint que 13%. Les 7 années suivantes, de 1971 à 1977, il a atteint 55% chez 65 opérés dont 29 sont actuellement vivants sans aucune trace de rétention biliaire. Au cours des 6 dernières années la rétention biliaire a été traitée avec succès chez 66% d'un groupe de 53 sujets, dont plus de la moitié ne présente aucune trace d'ictère. L'analyse rétrospective de cette série permet de définir les facteurs qui contribuent à l'amélioration des résultats opératoires: (a) diagnostic et intervention précoces, (b) dissection précise et section adéquate du moignon biliaire, (c) progrès du traitement postopératoire, (d) prévention de l'angiocholite postopératoire, et (e) réintervention précoce si nécessaire. La chirurgie correctrice pratiquée au cours des 60 premièrs jours qui suivent la naissance permet d'obtenir un drainage biliaire suffisant, un taux normal de bilirubine étant constaté chez 80% des opérés.

Resumen

Aun cuando los resultados de la cirugia para atresia biliar han mejorado en forma notoria después de la introducción de la portoenterostomía hepática, todavía es necesario un mayor progreso. En los 31 anos transcurridos entre 1953 y 1983, hemos realizado cirugía correctiva en 214 pacientes. En los primeros 18 años la enfermedad pudo ser exitosamente tratada sólo en el 13% de 96 pacientes. En los 7 años siguientes (1971 a 1977), la ictericia pudo ser controlada en el 55% de 65 pacientes; actualmente 29 pacientes se hallan vivos y libres de ictericia. En los Ultimos 6 años la ictericia ha sido controlada en el 66% de 53 pacientes; más del 50% de los pacientes se hallan libres de ictericia en la actualidad. El análisis retrospectivo ha identificado algunos factores de importancia que contribuyeron a la superación de los resultados operatorios: (a) diagnóstico y operatión precoces; (b) disección precisa y transección adecuada del cono fibroso del remanente extrahepático del canal biliar; (c) progresos en el manejo postoperatorio; (d) preventión de la colangitis postoperatoria; y (e) reoperación temprana cuando necesario. La cirugía correctiva realizada dentro de los 60 días después del nacimiento puede lograr un drenaje biliar suficiente para la normalización del nivel de bilirrubina sérica en más del 80% de los pacientes.

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Copyright information

© Société Internationale de Chirurgie 1985

Authors and Affiliations

  • Ryoji Ohi
    • 1
  • Masahiro Hanamatsu
    • 1
  • Izumi Mochizuki
    • 1
  • Tsuneo Chiba
    • 1
  • Morio Kasai
    • 1
  1. 1.Division of Pediatric Surgery and Second Department of SurgeryTohoku University School of MedicineSendaiJapan

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