Interposition jejunal loop with valve for management of biliary atresia

ABSTRACT

Kasai's operation has changed significantly the prognosis of patients with biliary atersia. However, postoperative ascending cholangitis is still a relatively frequent complication with high morbidity and mortality rates. Several surgical procedures to overcome the high incidence of postoperative ascending cholangitis after Kasai operation have been introduced. The aim of this study is to investigate the effect of the jejunal interposition hepatic portoduodenostomy with an intussusception type intestinal valve on the incidence of the post-operative cholangitis in cases of biliary atresia at our institute. Ten cases of biliary atresia [from June 1995 to January 1997], were included in the study. Seven were females and 3 males, with mean age at the time of operation of 67.8 days and mean body weight of 4.37 Kgm. There was no intraoperative mortality, while hospital mortality was 30%; the cause of death was not related to the surgical procedure. The remaining 7 patients were followed up for a period ranged from 6 to 17 months with a mean of 10.7. Three [42.8%] of the 7 patients did not develop any attacks of cholangitis, the other 3 developed one attack of grade I; cholangitis and the remaining one had 4 attacks of grade II; cholangitis and reoperation for him was considered. Upper GIT study using Gastrografin demonstrated competence of the artificially constructed valve in all survivors. The results obtained in this study demonstrate that interposition jejunal loop with an anti-reflux intestinal valve has prevented the incidence of cholangitis and reduced the number as well as the severity of the attacks of cholangitis in 85.7% of the studied patients with biliary aterisa