Surgery 1975 Jul;78(1):76-86

Hepatic portoenterostomy (the Kasai operation) for biliary atresia

Lilly JR, Altman RP

Abstract
Twenty-two infants and children with extrahepatic biliary atresia were treated
by Kasai's hepatic portoenterostomy operation since 1972. Postoperative bile
drainage occurred in 11 infants. Success never was obtained in patients older
than 12 weeks nor in the absence of microscopic biliary ductules in the excised
fibrotic remnant of the extrahepatic bile ducts. With these exclusions almost 90
percent of infants with biliary atresia had sustained bile drainage after
operation. In the early cases, ascending cholangitis was a major and recurrent
complication with sequellae in many instances of permanent jaundice and probably
irreversible liver damage. A new and simple modification of Kasai's original
operation has prevented this complication thus far. Despite apparently normal
bile drainage, postoperative studies by transhepatic cholangiography in some of
these patients have demonstrated a grossly abnormal hepatobiliary
intrastructure, suggesting that an underlying liver involvement may be present
in biliary atresia