[Portal hypertension after successful hepatic portoenterostomy in biliary atresia].
Sixty percent of 139 patients with biliary atresia who underwent hepatic portoenterostomy (Kasai operation) from 1965 to 1994 became jaundice-free after the operation. Portal hypertension, which was confirmed by endoscopic observation of esophageal varices and/or thrombocytopenia (less than 100 x 10(3)/mm3), developed in 50% of unicteric long-term survivors. Esophageal varix was found initially between 11 months and 5 years of age in more than 70% of these portal hypertensive patients. On the contrary, thrombocytopenia developed at 6 years or older age in 63% of the patients. The incidence of portal hypertension was significantly lower in the patients whose serum bilirubin decreased less than 2mg/dl at 3 months after surgery than in the patients whose bilirubin stayed over 2mg/dl at the same postoperative time. Furthermore, re-do operation related significantly to the incidence of portal hypertension in jaundice-disappeared patients. Prophylactic endoscopic injection sclerotherapy and/or variceal ligation were sufficiently effective in the management of esophageal varices. Partial splenic embolization as well as splenectomy seems to be a treatment of choice for hypersplenism.
Department of Surgery, National Children's Hospital, Tokyo, Japan.
M
M
Saeki
T
T
Honna
M
M
Nakano
T
T
Kuroda
D000293:Adolescent; D001656:Biliary Atresia / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004932:Esophageal and Gastric Varices / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology*; D007223:Infant; D007565:Jaundice / Q000209:etiology; D011171:Portoenterostomy, Hepatic; D011183:Postoperative Complications; D013921:Thrombocytopenia / Q000209:etiology; D013997:Time Factors