THE ANATOMY OF THE PORTA HEPATITIS IN PATIENTS WITH PREDUODENAL PORTAL-VEIN, WITH SPECIAL REFERENCE TO PORTOENTEROSTOMY FOR BILIARY ATRESIA

The aims of this study were to demonstrate the anatomic relationship b etween portal vein (PV) branches and hepatic ducts in the porta hepati s in individuals with preduodenal portal vein (PDPV) and to examine th e validity of portoenterostomy (Kasai procedure) for patients with bil iary atresia (BA) and PDPV. The porta hepatis of four subjects with PD PV without BA was dissected. Similar dissection supplemented by comput er-aided three-dimensional reconstruction of the hilar structures was undertaken in a patient with BA and PDPV who underwent an unsuccessful Kasai procedure and died at 5 months of age. In three of the four sub jects with PDPV alone, PV branches and extrahepatic bile ducts were ab normally arranged in the porta hepatis, some of the hepatic ducts ente ring the liver substance posterior, and occasionally lateral, to the m ain PV branches. The three-dimensional study showed that the original right main intrahepatic bile duct was located anterolateral to the por toenterostomy, which had been placed just anterior and to the right of the PV bifurcation. These findings strongly suggest that the PV may n ot be a reliable landmark for the Kasai procedure in patients with BA and PDPV.