Modified hepatic portal enterostomy for biliary atresia

Macroscopic and microscopic studies of the portal tract in liver specimens obtained at autopsy from 5 noncorrectable biliary atresia patients were performed. The studies disclosed that major intrahepatic bile ducts had disappeared for variable distances in noncorrectable biliary atresia patients. However, the topographic relationship between intrahepatic bile ducts and blood vessels was just the same as in normal livers. On the basis of these studies, we preformed more extensive portal exploration in order to get closer to the obstructed ends of major intrahepatic bile ducts. Hepatic portal enterostomy was also modified to avoid obstruction of the explored area by the jejunal wall to be anastomosed The results of 7 patients who received the new operation were encouraging with complete loss of jaundice in 6 of 7 patients.