OUTCOMES OF ILEOCOLIC CONDUIT FOR BILIARY DRAINAGE IN INFANTS WITH BILIARY ATRESIA - COMPARISON WITH ROUX-EN-Y TYPE RECONSTRUCTION

This study was undertaken to define the role of an ileocolic conduit t hat was devised as anti-reflux procedure in comparative study with Rou x-en-Y type reconstruction in infants with biliary atresia treated at a single institution. The ileocolic conduit (IC) consisted of 30 cm of distal ileum anastomosed to the portahepatis and a 10-cm segment of a scending colon vented through the abdominal wall, which was later anas tomosed to the second portion of the duodenum. In the Roux-en-Y type r econstruction (RY), 40 to 60 cm of jejunum was used for the hepatic li mb. Twenty-three infants in group IC and 16 infants in group RY were e ntered in this study. Mean ages at definitive surgery were 65.3 +/- 23 .1 days for group IC and 65.0 +/- 19.5 days for group RY. The two grou ps were compared for the postoperative outcomes in terms of bile excre tion, incidence of cholangitis, esophageal varices, survival rate, and the effects on physical development. The follow-up ranged from 4 to 1 5 years. Bile excretion was obtained in all infants in both groups. Tw enty infants (87.0%) in group IC and 10 infants (62.5%) in group RY be came anicteric. Cholangitis occurred in 60.9% of group IC, compared wi th 83.3% for group RY, in which 6 infants required revision to complet e diversion of Roux-en-Y limb (Suruga II), There was the same occurren ce rate of esophageal varices for both groups. However, the varices te nded to develop later in group IC (53.0 +/- 18.4 months) than in group RY (12.7 +/- 6.0 months) (P < .02). The 4-year survival for group IC was 73.9%, compared with 43.8% for group RY (P < .01). Among the survi vors 77.3% of patients had a BAPI score of <50. A BAPI of <25, indicat ing good quality of life with near normal liver function, was seen in 53.3% of the patients in group IC, compared with only 28.6% in group R Y. The patients in group IC had lower mean Z scores for height and wei ght (-1.9 +/- 1.7, -0.8 +/- 1.0) compared with the patients in group R Y (-0.5 +/- 1.5, +0.1 +/- 1.1) at the time of last follow up. The ileo colic conduit played a role in decreasing the morbidity of ascending c holangitis and improving the patient survival and quality of life, alt hough some metabolic and physiological drawbacks were present. Copyrig ht (C) 1995 by W.B. Saunders Company