Bile duct size does not predict success of portoenterostomy for biliary atresia

Background/Purpose: Presence of large bile ducts (>200 mu m) at the portal end-plate has been suggested to predict success after portoenterostomy. The authors reviewed their patients with biliary atresia to test the hypothesi s that bile duct size in patients with successful portoenteroslomy was no d ifferent than in the patients with unsuccessful portoenterostomy. Methods: The authors reviewed the patients at their institution from 1989 t o 1998 who had the diagnosis of biliary atresia (n = 38). A pathologist bli nded to the results of the operation confirmed the measurements of the bile duct remnants. Results: Five of the 38 patients did not have a portoenterostomy. They unde rwent cholangiogram and liver biopsy and were evaluated for liver transplan tation. All patients who underwent surgery(n = 33) had a Roux-en-y hepatico jejunostomy, Twenty-one patients had successful surgery (64%) and 12 patien ts (36%) had unsuccessful surgery. The average age at operation in the succ essful group was 50.9 +/- 3 days and in failures, 57.9 +/- 4 days (P = .16) . Duct size at the portal end-plate was not different between the successes and failures. Two of the patients in the success group had no evidence of bile ducts grossly or histologically. Conclusion: Children presenting early in infancy (<3 months) with biliary a tresia should undergo a portoenterostomy regardless of the size of the bile ducts at the time of exploration. Copyright (C) 2000 by W.B. Saunders Comp any.