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Technique and results of operative management of biliary atresia

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Abstract

Intrahepatic bile ducts are patent in the liver of patients with biliary atresia in early infancy. Small bile ducts at the porta hepatis continuing to the intrahepatic ducts usually terminate in fibrous tissue replacing the hepatic radicles, which does not extend to the common hepatic duct. Therefore, the level of transection of the fibrous tissue at the porta hepatis is of prime importance for successful hepatic portoenterostomy. Transection should be done at the level of the posterior surface of the portal vein. The overall cure rate of surgery for biliary atresia was 30%. In our recent series, however, the results have markedly improved and the cure rate has been increased to 55%. There are 47 patients living without jaundice, 22 of them for more than 5 years. The longest survivors are 23 years old. All the longterm survivors are leading a normal life for their age, although 6 of them have some physical or mental handicap. Early operation, adequate surgical technique, and prevention of postoperative cholangitis are requisites for successful hepatic portoenterostomy.

Résumé

Chez les nouveaux-nés atteints d'atrésie biliaire, les canaux biliaires intra-hépatiques sont perméables. Dans le hile hépatique, ces canaux intrahépatiques se terminent par de fins canalicules enserrés dans du tissu fibreux, qui ne se poursuivent pas jusqu'au canal hépatique commun. Le niveau de section du tissu fibreux dans le hile hépatique est donc très important pour le succès de l'hépaticoentérostomie. Cette section doit être faite au niveau de la face postérieure de la veine porte. La chirurgie pour atrésie biliaire donnait 30% de guérisons. Dans notre récente série, les résultats ont été améliorés jusqu'à 55% de guérisons. Nous avons 47 malades qui vivent sans ictère, dont 24 depuis plus de 5 ans. Les plus longues survies atteignent 23 ans. Tous ont une vie normale pour leur âge, malgré le fait que 7 d'entre eux présentaient certains handicaps physiques ou mentaux. Le succès de l'hépaticoentérostomie dépend de la précocité de l'intervention, de la qualité de la technique opératoire et de la prévention de l'angiocholite postopératoire.

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Authors and Affiliations

  1. The Second Department of Surgery, Tohoku University School of Medicine, Seiryochi, 1-1, Sendai, Japan

    Morio Kasai M.D., Hiroshi Suzuki M.D., Eisuke Ohashi M.D., Ryoji Ohi M.D., Tsuneo Chiba M.D. & Atsutake Okamoto M.D.

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  1. Morio Kasai M.D.
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  2. Hiroshi Suzuki M.D.
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  3. Eisuke Ohashi M.D.
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  4. Ryoji Ohi M.D.
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  5. Tsuneo Chiba M.D.
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  6. Atsutake Okamoto M.D.
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Kasai, M., Suzuki, H., Ohashi, E. et al. Technique and results of operative management of biliary atresia. World J. Surg. 2, 571–579 (1978). https://doi.org/10.1007/BF01556048

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