title: A modification of hepatic portoenterostomy (Kasai operation) for biliary atresia.
abstract: BACKGROUND
  Although the proportion of patients with biliary atresia remaining jaundice-free after hepatic portoenterostomy (i.e., Kasai operation) has recently been increasing, in many cases repeated reoperation is required to achieve this result. Also, with assessment of jaundice using 2.0 mg/dL of serum total bilirubin as the cutoff, progressive liver fibrosis has occurred in longterm survivors, making liver transplantation necessary. Reoperations result in difficulty in removing the liver for this purpose and cause an increase in the probability of sequelae.
  
  
  METHODS
  We have performed a new modification of the Kasai operation on a series of patients using the Cavitron ultrasonic suction aspirator (CUSA) for obtaining persistent biliary drainage. We assessed the results using <1.5 mg/dL of serum total bilirubin as the criterion for jaundice-free patients.
  
  
  RESULTS
  Since 1988, 39 patients were available for review of their clinical results to evaluate our new modification. Thirty patients (77%) were completely and continuously free of jaundice, without living-related liver transplantation or reoperation, and the maximum level of total bilirubin was <1.1 mg/dL.
  
  
  CONCLUSIONS
  Our new approach to Kasai operations using CUSA as an integral aid to freeing the biliary remnants and facilitating enteric anastomosis is effective for persistent and complete disappearance of jaundice, without complicated reconstruction or reoperation, and decreases the need for liver transplantation.
authors.affiliation: First Department of Surgery, Nagoya City University Medical School, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Y
authors.initials: Y
authors.lastname: Otobe
authors.forename: Y
authors.initials: Y
authors.lastname: Shimizu
authors.forename: T
authors.initials: T
authors.lastname: Suzuki
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
authors.forename: S
authors.initials: S
authors.lastname: Hayashi
authors.forename: Y
authors.initials: Y
authors.lastname: Matsuo
authors.forename: M
authors.initials: M
authors.lastname: Sato
authors.forename: T
authors.initials: T
authors.lastname: Manabe
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000379:methods; D001656:Biliary Atresia / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000295:instrumentation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D011379:Prognosis; D013396:Suction / Q000295:instrumentation; D015996:Survival Rate; D013536:Suture Techniques; D014464:Ultrasonic Therapy / Q000295:instrumentation