RELATIONSHIP BETWEEN INTRAOPERATIVE CHOLANGIOGRAPHIC PATTERNS AND OUTCOMES IN BILIARY ATRESIA

Intraoperative cholangiography revealed biliary tracts in 11 of 25 (44 %) patients with biliary atresia, The outcome of these 11 patients was analyzed based on the cholangiographic patterns. In these 11 patients , 4 cases were the I-cyst type, 3 showed a ''cloudy shadow'' pattern i n the intrahepatic biliary tract, and 4 were subtype ''a'' pattern (di stally patent common bile duct). Four patients showing the I-cyst type underwent hepaticojejunostomy with Roux-en-Y anastomosis, and all of the 4 became jaundice-free a few weeks after surgery. Three patients w ith the ''cloudy shadow'' pattern gained good bile drainage after hepa tic portoenterostomy with Suruga II modification, all were complicated by ascending cholangitis. Three of the 4 subtype ''a'' pattern underw ent hepatic portoenterostomy with Suruga II modification. Two became j aundice-free, while jaundice persisted in one. The subtype ''a'' patie nt who underwent hepatic porto-cholecystostomy showed poor bile draina ge, and died of hepatic failure 17 months after surgery despite furthe r surgery. From these results, we conclude that 1) hepatico-jejunostom y with Roux-en-Y anastomosis is indicated for I-cyst biliary atresia. 2) Prevention of ascending cholangitis is important in patients with t he ''cloudy shadow'' pattern. 3) Hepatic porto-jejunostomy is indicate d for the subtype ''a'' pattern rather than hepatic porto-cholecystost omy.