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December 1975

Surgery of Biliary Atresia: Current Status

Author Affiliations

From the Division of Pediatric Surgery (Dr Lilly), and the departments of pediatrics (Dr Schroter), pathology (Dr Shikes), and radiology (Dr Taubman), University of Colorado Medical Center, Denver; and the Department of Surgery, Children's Hospital National Medical Center, Washington, DC (Dr Altman).

Am J Dis Child. 1975;129(12):1429-1432. doi:10.1001/archpedi.1975.02120490041013

Currently, no single area in pediatric surgery arouses more heated controversy than does the surgical treatment of biliary atresia. Because of reports (few have been published) of spontaneous resolution of biliary atresia, only limited operations have been recommended to avoid damage to unrecognized ductal structures. Conversely, because of other reports of correctable lesions "missed" at operation and subsequently discovered at autopsy, a thorough surgical exploration has been urged. The dilemma has not been helped any by communications from Japan about another operation for biliary atresia in which the extrahepatic bile ducts are removed entirely.

For a while, most American pediatric surgeons simply ignored the Japanese communications. This action, or lack of action, was subsequently believed fully justified after the initial pessimistic report in the United States by Campbell and associates.1 After experiencing ten outright failures in ten successive patients, the authors legitimately concluded "... that hepatic portoenterostomy appears

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