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Advances in treatment of biliary atresia

The Japanese journal of surgery volume 13, Article number: 265 (1983) Cite this article

Abstract

During 29 years from 1953 through 1981, 224 patients with congenital biliary atresia were treated and 200 of them underwent corrective operation at the Second Department of Surgery, Tohoku University Hospital. With the advance of surgical techniques and early diagnosis of biliary atresia, the rate of jaundice disappearance improved from the initial 15 per cent to Hre recent 69 per cent. Important factors contributing to the improvement of operative results included (1) an early operation, preferably within 60 days after birth, (2) a precise dissection and adequate transection of the porta hepatis, (3) prevention of post-operative cholangitis and (4) reoperation if indicated. Delayed operation and occurrence of post-operative results. Although, nearly all the patients with biliary atresia had portal hypertension at the time of surgery, the portal vein pressure decreased after successful operation, mainly due to improvement in portal venous circulation of the liver. It is considered from recent operative results that more than 80 per cent of patients with biliary atresia can be cured when an adequate corrective operation is carried out before 60 days of age and post-operative cholangitis is prevented.

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References

  1. Valayer, J.: Portal hypertension in biliary atresia, International Workshop on Biliary Atresia. 1981, New York.

  2. Smith, E. D.: Personal communication.

  3. Altman, R. P.: Long term results after Kasai Procedure, International Workshop on Biliary Atresia. 1982, New York.

  4. Hitch, D. C., Shikes, R. H. and Lilly, J. R.: Determinations of survival after Kasai's Operation for biliary atresia using acturial analysis. J. Pediatr. Surg. 14: 310–314, 1979.

    PubMed  CAS  Google Scholar 

  5. Mustard, R. Jr., Shandling, B. and Gillam, J.: The Kasai Operation (Hepatic portoenterostomy for biliary atresia—Experience with 20 cases. J. Pediatr. Surg. 14: 511–514, 1979.

    PubMed  Google Scholar 

  6. Howard, E. R.: Surgery for biliary atresia: Personal experience with 88 cases. International Workshop on Biliary Atresia, 1982, New York.

  7. Caccia, G.: Results of biliary atresia treatment in Italy, Cholestasis in Infancy, pp. 359–365, University of Tokyo Press, Tokyo, 1980.

    Google Scholar 

  8. Weber, T. R., Grosfeld, J. L. and Fitzgerald, J. F.: Prognostic determinations after hepatic portoenterostomy for biliary atresia, Amer. J. Surg. 141: 57–60, 1981.

    PubMed  CAS  Article  Google Scholar 

  9. Kim, W.: Personal Communication.

  10. Lilly, J. R., Stellin, G., Pau, C. M. L. and Ohi, R.: Biliary Atresia Registry: Surgical Section of American Academy of Pediatrics. International Workshop on Biliary Atresia, 1981, New York.

  11. Chiba, T., Kasai, M. and Sasano, H.: Histopathological studies on intrahepatic bile ducts in the vicinity of porta hepatis in biliary atresia. Tohoku J. Exp. Med. 118: 199–207, 1976.

    PubMed  CAS  Google Scholar 

  12. Okamoto, A., Ohi, R. and Kasai, M.: Histologic study on the bile ducts at porta hepatis in five cases of extrahepatic biliary atresia. J. Jap. Soc. Pediat. Surg. 14: 539–548, 1978 (in Japanese)

    Google Scholar 

  13. Kasai, M., Suzuki, H., Ohashi, E., Ohi, R., Chiba, T. and Okamoto, A.: Technique and results of operative management of biliary atresia. World J. Surg. 2: 517–580, 1978.

    Google Scholar 

  14. Ohi, R., Kasai, M. and Takahashi, T.: Intrahepatic biliary obstruction in congenital bile duct atresia. Tohoku J. Exp. Med. 99: 129–149, 1969.

    Article  Google Scholar 

  15. Kasai, M.: Treatment of biliary atresia with special reference to hepatic portoenterostomy and its modifications. Progress Pediatr. Surg. 6: 5–52, 1974.

    CAS  Google Scholar 

  16. Tazawa, Y. and Konno, T.: Semiquantitative assay of serum Lipoprotein-X in differential diagnosis of neonatal hepatitis and congenital biliary atresia. Tohoku J. Exp. Med. 130: 209–217, 1980.

    Google Scholar 

  17. Sawaguchi, S., Nakajo, T., Hori, T., Harada, Y. and Obe Y.: The treatment of congenital biliary atresia with special reference to hepatic portoentero anastomosis. Fifth Annual Meeting of the Pacific Association of Pediatric Surgeons, 1972, Tokyo.

  18. Suruga, K., Kono, S., Miyano, T., Kitahara, T., Chin, C. S.: Microsurgery for hepatic portoenterostomy. Surgery 80: 558–562, 1976.

    PubMed  CAS  Google Scholar 

  19. Ueda, T., Kujiraoka, Y., Fujino, T., Chen, H. R., Okamoto, E., Ohkuma, E. and Miyata, Y.: Results of hepatoporto-jejunostomy for uncorrectable biliary atresia. Firth Annual Meeting of the Pacific Association of Pediatric Surgeons, 1972, Tokyo.

  20. Kasai, M.: Hepatic portoenterostomy and its modifications, Cholestasis in Infancy, pp. 337–344, University of Tokyo Press, Tokyo, 1980.

    Google Scholar 

  21. Okamoto, E.: Operative Technique for CBA and its results. Jap. J. Pediatr. Surg. 10: 697–701, (in Japanese).

  22. Hasegawa, H. and Tai, Y.: Reconstruction of bile duct by gastroepiploic rolled island flap. Plastic Surgery 19: 395–297, 1976 (in Japanese).

    Google Scholar 

  23. Tanaka, K., Kohno, M., Nakajima, Y., Hanfusa, T., Mieuno, K., Maruhashi, K., Kato, H., Nakamoto, K., Matsukawa, Y. and Satomura, K.: Jejunal interposition hepatic portoduodenostomy with intestinal valve for treatment of biliary atresia. Jpn. J. Pediatr. Surg. 13: 733–739, 1981 (in Japanese).

    Google Scholar 

  24. Endo, M., Nakano, M., Kamagata, S., Hayashi, K., Morikawa, Y., Yokoyama J. and Katsumata, K.; The biliary cutaneous conduit using ileocecal segment for the prevention of reflux cholangitis in biliary atresia. Jpn. J. Pediatr. Surg. 13: 749–754, 1981 (in Japanese).

    Google Scholar 

  25. Ikeda, K.: Hepatic portogastrostomy, Shujutsu 29: 9–13, 1975 (in Japanese).

    Google Scholar 

  26. Toyosaka, A., Okamoto, E., Kuwata, K., Ohashi, S., Ueki, S., Shu, A., Nishiura, N. and Okasora T.: Follow up studies of long-term surviors after hepatic portoenterostomy for biliary atresia. Jpn. J. Pediatr. Surg. 12: 1073–1084, 1980 (in Japanese).

    Google Scholar 

  27. Saeki, N., Akiyama, H., Ogata, T.: Portal hypertension after successful hepatic portoenterostomy for biliary atresia. Jpn. J. Pediatr. Surg. 12: 1059–1064, 1980. (in Japanese).

    Google Scholar 

  28. Hays, D. M. and Kimura, K.: Portal hypertension in biliary atresia: The Japanese Experience, pp. 127–132, Harvard University Press, Cambridge, Massachusetts, 1980.

    Google Scholar 

  29. Odiévré, M.: Long-term results of surgical treatment of biliary atresia. World J. Surg. 2: 589–594, 1978.

    PubMed  Article  Google Scholar 

  30. Kasai, M., Okamoto, A., Ohi, R., Yabe, K., Matsumura, Y.: Changes of portal vein pressure and intrahepatic blood vessels after surgery for biliary atresia. J. Pediatr. Surg. 16: 152–159, 1981.

    PubMed  CAS  Google Scholar 

  31. Ouchi, N., Ohi, R. and Kasai, M.: Morphological study of intrahepatic portal vein structure. 9th Tandoheisasho Kenkyukai, 1982, Sapporo, Jpn.

  32. Starzl, T. E.: Liver transplantation, International Workshop on Biliary Atresia, 1981, New York.

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  1. Department of Surgery, Tohoku University School of Medicine, 1-1 Seiryo-cho, 980, Sendai, Japan

    Morio Kasai

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  1. Morio Kasai
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Kasai, M. Advances in treatment of biliary atresia. The Japanese Journal of Surgery 13, 265 (1983). https://doi.org/10.1007/BF02469507

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  • DOI: https://doi.org/10.1007/BF02469507

Key Words

  • biliary atresia
  • hepatic portoenterostomy
  • infantile obstructive jaundice
  • biliary cirrhosis