Ann Surg 1991 Mar;213(3):230-5

A valved hepatic portoduodenal intestinal conduit for biliary atresia

Tanaka K, Shirahase I, Utsunomiya H, Katayama T, Uemoto S, Asonuma K, Inomata Y,
Ozawa K
Second Department of Surgery, Kyoto University, School of Medicine, Japan.

Abstract
Forty-six consecutive patients with biliary atresia were operated on at our
institution during the 11-year period between 1978 and 1989. Their ages at
operation ranged from 18 to 153 days (mean, 59 days). After dissecting the porta
hepatis structures by Kasai operation, a biliointestinal anastomosis was
constructed with a valved hepatic portoduodenal intestinal conduit in all cases.
The intestinal valve is an intussuscepted muscular valve. Valvular function was
examined radiologically. The upper gastrointestinal series demonstrated no
reflux of contrast material into the conduit proximal to the valve and liver
scintigraphy demonstrated that radioactive isotope drained readily into the
duodenum through the valve. Thirty-nine of the forty-six patients (85%) had bile
drainage after initial operation. At present 30 patients (65%) are alive without
jaundice, 6 (13%) are alive with jaundice, and 10 (22%) are dead. The 5-year
jaundice-free survival rate was 64%. Cholangitis occurred in 9 of 39 patients
(23%) who had obtained apparent bile drainage: 5 had tractable cholangitis and 4
had refractory cholangitis. Reoperation restored bile flow in 2 of 8 patients
who abruptly ceased to have bile drainage without cholangitis. In conclusion,
with a valved hepatic portoduodenal intestinal conduit, the incidence of
cholangitis was decreased, its medical control became easier, and the survival
rate was improved