FURTHER EXPERIENCE WITH THE ANTIREFLUX VALVE TO PREVENT ASCENDING CHOLANGITIS IN BILIARY ATRESIA

Background/Purpose: The intussusception-type antireflux valve is a mec hanism introduced by Nakajo, who reported the results of his initial 1 7 cases in 1990. This report summa rites our further experience with n ew patients, together with follow-up results of the cases previously r eported by Nakajo. Methods: In total, 46 new patients who had biliary atresia underwent portoenterostomy at the authors' two units. The auth ors hoped to construct the intussuscepted antireflux valve in the Roux -en-Y loop, whenever possible, at the time of hepatic portoenterostomy . Results: Among the 46 patients, one case each was found to be too yo ung or too old to have the valve constructed during the surgery. In an other case, the Roux-en-Y loop became too short after repeated revisio ns of the portoenterostomy. In another patient, the valve was first co nstructed but later removed because of jejunal perforation near the va lve, In the last patient, the valve was not constructed for unspecifie d reasons. The authors constructed the antireflux valve in 42 patients , but it was maintained in 41, In one case, the valve truly prevented reflux of the intestinal juice during an episode of intestinal obstruc tion. The valve was found to be incompetent in one patient 5 years aft er the initial surgery. Conclusion: The incidence of cholangitis was h igh in patients with postoperative cystic dilatation of the intrahepat ic bile ducts, and low in those without it. Copyright (C) 1997 by W.B. Saunders Company.