Progress in the treatment of biliary atresia

Abstract Although the surgical results of biliary atresia have markedly improved following the introduction of hepatic portoenterostomy, further improvement is necessary. In a 31‐year period, from 1953 through 1983, we performed corrective surgery on 214 patients. In the first 18 years the disease was successfully treated in only 13% of 96 patients. In the next 7 years (1971 to 1977), jaundice was cleared in 55% of 65 patients, now 29 patients are alive without jaundice. In the last 6 years, the jaundice was cleared in 66% of 53 patients; more than 50% of patients are now without jaundice. Retrospective analysis revealed several important factors contributing to the improvement of operative results: (1) early diagnosis and operation, (b) precise dissection and adequate transection of the bile duct remnant, (c) progress in the postoperative management, (d) prevention of postoperative cholangitis, and (e) early reoperation whenever necessary. Corrective surgery performed within 60 days after birth can achieve sufficient bile drainage to normalize serum bilirubin level in more than 80% of the patients.