Extensive dissection at the porta hepatis for biliary atresia

Evidence for segmental bile drainage by hepatic portoenterostomy for biliary atresia: cholangiographic, hepatic venographic, and histologic evaluation of the liver taken at liver transplantation

“…These assumptions are supported by the anatomic structure of the bile duct at the porta hepatis. The bile ducts from segments IV, V, and VIII are situated at sites medial and superior to the portal branches and those from segments II, III, VI, and VII are situated at lateral and posterior sites in the portal branches, 4,9 which are areas situated near the anastomosis site of portoenterostomy. Moreover, we also used MRI in studying postoperative patients and found that some patients had atrophic or fibrous changes in more than 1 liver lobe or in the peripheral zone 1 year after portoenterostomy.…”

“…[2][3][4] Although about 30% to 40% of patients who have decreased jaundice have liver function in the normal range, 5,6 some patients have worsening liver function in the long term after successful portoenterostomy. 2, 3,5 The cause of the progressive liver dysfunction has not been ascertained clearly.…”

Innovative modification of the hepatic portoenterostomy. Our experience of treating biliary atresia

“…Endo et al [2] reported extending the usual dissection of the porta hepatis and reported 12 of 15 patients became jaundice-free (5 had double Roux-en-Y loops and 10 had intussuscepted ileocolic conduits for preventing ascending cholangitis), although 2 of the 12 subsequently became jaundiced again. Toyosaka et al [3] reported 4 of 16 cases developed biliary reobstruction after 100% bile drainage was achieved (2 in the early postoperative period and 2 in the late postoperative period). However, although these results are much better than recent Japanese results obtained from the 2003 Japanese biliary atresia register where only 49 of 79 cases (62%) became jaundice-free postoperatively [4], these modifications are difficult and require more experience and skill to perform.…”

“…Several reports have emphasized the value of a more extensive lateral dissection at the porta hepatis compared with the original Kasai procedure [1][2][3]. Ando et al [1] reported dividing the ligamentum venosum to expose the porta hepatis more extensively and obtained good bile flow in all 6 cases it was used in.…”

“…Several institutions in Japan have reported improved results by extending the Kasai procedure at the porta hepatis [1][2][3]. We modified the conventional hepatic portoenterostomy (HPE) to simplify the procedure and present our experience of treating 14 cases.…”