Extended dissection of the portahepatis and creation of an intussuscepted ileocolic conduit for biliary atresia

Endo, Makoto; Katsumata, Keizo; Yokoyama, Jotaro; Morikawa, Yasuhide; Ikawa, Hiromichi; Kamagata, Shoichiro; Nakano, Masaaki; Nirasawa, Yuji; Ueno, Shigeru

doi:10.1016/s0022-3468(83)80024-4

Cited by 60 publications

(27 citation statements)

References 10 publications

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“…About 20-30 years ago, many institutions developed their own antireflux procedures to perform at the time of portoenterostomy [4][5][6][7][8]. However, despite becoming jaundicefree initially, many of these patients gradually developed cirrhosis and portal hypertension over time and as adults required LT. Because of the variety of procedures that were developed, it has come to the point where the long-term outcome of these antireflux procedures including our HPI ought to be assessed because such information could affect prognosis and influence the outcome of LT. HPI hepatic portoduodenostomy with interposition of the ileocecoappendix, R-Y Roux-en-Y jejunostomy to the interposed ileocecum, LT liver transplantation Fig.…”

Section: Discussionmentioning

confidence: 99%

“…2 The arrowheads indicate the interposed cecum. Note several stones Antireflux procedures such an intussusception or a mucosal flap valve in a Roux-en-Y limb, biliary appendicoduodenostomy, or ileocecal valve have been advocated to prevent cholangitis [4][5][6][7][8][10][11][12][13]. However, they are generally associated with complications irrespective of whether they are effective against cholangitis or not [3,9,[14][15][16].…”

Section: Discussionmentioning

confidence: 99%

“…Despite improved postsurgical outcome, cholangitis complicates 50-90% of postoperative BA patients [2,3]. Multiple varieties of intestinal conduits have been described for biliary reconstruction to prevent cholangitis, and an appendiceal graft or the ileocecal valve has been used as nonrefluxing conduits at several institutions [4][5][6][7][8]. The purpose of this study was to evaluate the longterm outcome of BA patients who had hepatic portoenterostomy with interposition of the ileocecoappendix (HPI).…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcome of hepatic portoduodenostomy with interposition of the ileocecoappendix for biliary atresia

et al. 2007

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Hepatic portoduodenostomy with interposition of the ileocecoappendix (HPI) can be used for the surgical treatment of biliary atresia (BA). The purpose of this study was to evaluate the long-term outcome of patients with HPI. The records of nine patients who had HPI performed for BA were reviewed. Mean age at portoenterostomy was 68.1 days (range 26-113 days). At the end of 2006, seven of the nine subjects were alive, although two required liver transplantation (LT). The two deaths occurred 94 days and 2 years after HPI due to varicella infection and variceal bleeding, respectively. Length of follow-up for the seven survivors ranged from 17 to 19 years (mean 18 years). Three subjects achieved normal liver function after HPI and have remained jaundice-free to date. Another three who were initially jaundice-free required Roux-en-Y jejunostomy (RYJ) to the ileocecum for severe obstructive cholestasis 6 months, 3 years, and 19 years after HPI secondary to stones in the cecum. RYJ was successful in these three cases, and liver function returned to normal within a few months. Two of these three have continued to have almost normal liver function, but one required LT 5 years after RYJ. The remaining case had LT because of liver dysfunction 14 months after HPI. There is a high risk for stone formation and obstruction with the HPI procedure because bile can stagnate in the ileocecum.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term outcome of hepatic portoduodenostomy with interposition of the ileocecoappendix for biliary atresia

et al. 2007

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“…Previously reported techniques using stomas to exteriorize the Roux limb or antireflux valves [113][114][115] have been subsequently abandoned either owing to associated complications or lack of effectiveness. [116][117][118] Similarly, use of the appendix as a conduit between the liver and the small intestine has been proposed but its use has been limited, with some reports suggesting an inferior surgical outcome.…”

Section: Surgical Controversiesmentioning

confidence: 99%

Biliary Atresia: A Multidisciplinary Approach to Diagnosis and Management

Moreira¹,

Cabral²,

Cowles³

et al. 2012

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Biliary atresia is an inflammatory cholangiopathy of infancy that results in progressive fibrosis and obliteration of bile ducts and represents the main indication for liver transplant in young children. In spite of extensive investigation, its etiology has remained poorly understood. Timely surgical intervention (Kasai procedure) may result in significant benefit to these patients and represents the final goal of an accurate diagnostic evaluation. Objective.—To present an overview of biliary atresia, including clinical and surgical approaches to this disease, with emphasis on the histopathologic evaluation. Data Sources.—Review of relevant literature indexed in PubMed (US National Library of Medicine). Conclusion.—A well-coordinated multidisciplinary approach is required in the assessment of suspected cases of biliary atresia. Pathologic examination of biopsy specimens is an integral part of the diagnostic algorithm and, therefore, plays a pivotal role in the diagnostic evaluation of this disease.

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“…Bei ausreichendem, eine Keimascension verhindernden GallefluB wird dieses dann etwa ein bis zwei Jahre sp~iter zurtickverlagert [4,12]. Ob sich allerdings hierdurch die kt~rzlich yon Endo et al [3] mitgeteilten Erfolgsziffern von 66,7% ikterusfreien Langzeitiiberlebenden gegentiber den schwankenden Ergebnissen bis zum Jahre 1978 von 17,9% bis 47,1% tatsachlich verbessern lassen, muB abgewartet werden.…”

Section: Gailengangsatresienunclassified

46. Neue Entwicklungen in der Kinderchirurgie

Holschneider

1984

Langenbecks Arch Chiv

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New concepts in pediatric surgery have been developed concerning inter-disciplinary problems such as ureter implantation or urinary undiversion as well as deformities of abdominal organs such as biliary atresia, anorectal malformations, adrenogenital syndrome and sinus urogenitalis. Considerable improvements in fetal surgery as a part of pediatric surgery were achieved. For diagnostic, surgical and ethical reasons, however, these efforts are, for the time being, only of theoretical interest.

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Extended dissection of the portahepatis and creation of an intussuscepted ileocolic conduit for biliary atresia

Cited by 60 publications

References 10 publications

Long-term outcome of hepatic portoduodenostomy with interposition of the ileocecoappendix for biliary atresia

Long-term outcome of hepatic portoduodenostomy with interposition of the ileocecoappendix for biliary atresia

Biliary Atresia: A Multidisciplinary Approach to Diagnosis and Management

46. Neue Entwicklungen in der Kinderchirurgie

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