Fifteen years' experience with an antirefluxing biliary drainage valve

Purpose: The aim of this study was to examine the efficacy of the antireflu xing, mucosal-flap valve (AMFV) for biliary drainage relative to technical feasibility, surgical complications, and incidence of ascending cholangitis (AC). Methods: Twenty-seven infants requiring biliary tract reconstruction underw ent valve construction. Twenty biliary atresia (BA) patients received the K asai procedure, and 7 choledochal cyst (CC) infants had cystectomy and hepa toenterostomy, A retrospective review of all patients was performed includi ng radiographic evaluation of the current valve function in 10 patients. Results: Construction was successful in all cases, and no morbidity was inc urred by incorporation of the valve. Of 7 CC patients, there have been no k nown episodes of AC with mean follow-up of 4.4 +/- 4.2 years. Of 20 BA pati ents, there have been 5 deaths (25%), 7 liver transplants (35%), 2 (10%) lo st to follow-up, and 6 (30%) survivors. Nine BA patients (45%) have had AC, with patients in all 4 outcome categories represented. Ten patients (5 CC and 5 BA) have been evaluated with barium small bowel radiographs, with no reflux to the liver hilum in all cases. Conclusions: The AMFV has caused no morbidity and continues to prevent refl ux to the liver hilum. Despite functioning as designed, it does not appear to influence the occurrence of AC. Because CC patients had no AC, we feel t hat infection is related to the underlying atresia rather than to reflux. C opyright (C) 1999 by W.B. Saunders Company.