Drainage of the biliary tree in infants with biliary atresia remains an unsolved problem, for more than 90% of such infants have an uncorrectable-type lesion, ie, no extra-hepatic bile duct is available for anastomosis to the intestine. The history of attempts to surgically circumvent this problem has been a most depressing one. Claims of success with procedures such as the use of artificial ducts to connect the liver and gastrointestinal tract1 and the drainage of thoracic duct lymph2,3 have all been short lived.
Biliary atresia, for unknown reasons, is much more common in Japan than in the United States. This had led to great interest in the surgical treatment of the disease by Japanese investigators. Kasai and associates, in 1957, first reported the use of hepatic portoenterostomy in the surgical treatment of uncorrectable types of biliary atresia.4 They originally claimed a cure rate of approximately 10%. More
Campbell DP. Hepatic Portoenterostomy: Indicated or Not in the Treatment of Biliary Atresia? Am J Dis Child. 1975;129(12):1427–1428. doi:10.1001/archpedi.1975.02120490039012
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