Anaesthesia, perioperative management and outcome of correction of extrahepatic biliary atresia in the infant: a review of 50 cases in the King's College Hospital series

Extrahepatic biliary atresia (EHBA) is an uncommon condition presenting in the first few weeks of life. It has an incidence of 0.5-1 per 10 000 live b irths and is the end result of a destructive inflammatory process involving the extrahepatic biliary system of unknown aetiology occurring in utero. T he net result is neonatal jaundice due to bile stasis, with subsequent hepa tocellular damage and cirrhosis. In the untreated, patient death is inevita ble within 2 years. Precise diagnosis (or exclusion) of EHBA in the persist ently jaundiced infant must be made urgently and major surgery (hepatic por toenterostomy: Kasai procedure) carried out as soon as possible, preferably before 6-8 weeks of age. This review is concerned with anaesthesia for cor rection of EHBA in 50 consecutive patients and also outlines the experience gained in the largest European centre for correction of EHBA where the num ber of cases now approaches 500.