Reappraisal of the role of the bilioenteric conduit in the pathogenesis ofpostoperative cholangitis

The incidence of postoperative cholangitis has changed very little despite progressive improvement in the treatment of biliary atresia. The role of th e bilioenteric conduit in its pathogenesis is still uncertain. A retrospect ive study of 39 patients undergoing either a conventional Kasai operation ( group 1, n = 20) or with placement of an antireflux valve (group 2, n = 10) or lengthening (group 3, n = 9) of the jejunal conduit from 40 to 60 cm wa s performed to compare the incidence of cholangitis. Postoperative cholangi tis developed in 18 of the 39 patients (46%). The incidence was 10/20 (50%) in group 1, 5/10 (50%) in group 2, and 3/9 (33%) in group 3 (P = 0.679). A n animal experiment was conducted concomitantly to compare quantitative bac terial cultures of the bilioenteric anastomosis and the liver before and 1 week after Roux-en-Y hepaticojejunostomy (HPJ) in piglets without (group A, 25 cm) and with (group B, 50 cm) lengthening of the jejunal conduit in a p orcine model of extrahepatic biliary obstruction. The growth of bacteria in both the bilioenteric anastomosis and the liver was not affected by length ening the jejunal conduit from 25 to 50 cm (P = 0.612 and 0.057, respective ly), despite a geometric increase in bacterial concentrations in both group s after HPJ. It is concluded that neither bacterial growth in the liver nor cholangitis following bile-duct reconstruction was affected by valving or lengthening the bilioenteric conduit.