J Pediatr Surg 1985 Dec;20(6):696-702

The valved conduit prevents ascending cholangitis: a follow-up

Reynolds M, Luck SR, Raffensperger JG

Abstract
Reflux of bacteria-laden intestinal contents into the biliary tree can be
prevented by an intussuscepted valve in an isolated segment of jejunum
interposed between the porta hepatis and the duodenum. This method of bile duct
reconstruction was adopted in 1979 and since then has been used in 17 children
with biliary atresia and 9 with choledochal duct cysts. Those with choledochal
duct cysts are well. Follow-up HIDA scans demonstrate normal bile flow, and
ultrasound examinations have not revealed dilated bile ducts. Bile flow was
established in 13 infants with biliary atresia and was persistent in 8. Two
expired because of unrelated problems between 2 to 6 months postoperatively. One
of these children developed cholangitis, but at autopsy the nipple valve was
incompetent. Six children currently have normal serum bilirubin levels and are
clinically well. The average postoperative stay for these patients was 7.5 days.
Three were rehospitalized for brief periods for suspected cholangitis which was
not proven. Bile flow was never established in 4 babies and was present only
briefly in 5. Five of these children died of progressive liver failure and one
from unrelated causes. Two have had liver transplants, and a third is awaiting
transplantation