title: Effects of invaginating anastomosis in Kasai hepatic portoenterostomy on resolution of jaundice, and long-term outcome for patients with biliary atresia.
abstract: OBJECTIVE
  This report describes a technique of hepatic portoenterostomy (HPE) to keep sustained bile drainage in biliary atresia patients. In conventional HPE, the medial posterior row of the anastomosis is placed behind the main portal vein. But around both lateral corners where the portal branches enter the liver parenchyma, the anastomosis is placed across and outside of the portal veins. Resultantly, the proximal part of the portal veins become included in anastomosis attaching directly to the dissected area where bile ducts are copious. In a devised procedure designated as invaginating anastomosis (IA), an anastomotic line was placed to invaginate the medial branch of the right portal vein and also placed behind the veins even at their roots. This technique puts all portal branches outside of the anastomosis, preventing cicatricial adhesion at the dissected area with the posterior wall of the veins.
  
  
  METHODS
  The effect of IA was evaluated in terms of resolution of jaundice and long-term outcome compared with conventional anastomosis (CA). Group IA consisted of 20 patients and group CA of 18 patients.
  
  
  RESULTS
  Patients in whom jaundice resolved included 19 (95%) in group IA and 11 (61%) in group CA (P < .05). Reoperation was needed in only one infant in group IA, and in six in CA (P < .05). In patients with reoperation in group CA, the portahepatis was found to be contracted with dense cicatricial tissues. The survival rates for patients with a native liver, calculated excluding those in whom the cause of death was not liver deterioration, was 87% for IA compared with 41% for CA (P < .05). Averaged biliary atresia prognostic index at the last follow-up evaluation was 20.2+/-24.5 for group IA and 62.6+/-29.8 for group CA (P < .001).
  
  
  CONCLUSIONS
  The invaginating anastomosis in portoenterostomy promised a sustained bile drainage and improved long-term outcome by preventing cicatricial contraction of the portahepatis.
authors.affiliation: Department of Pediatric Surgery, Urawa Municipal Hospital, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Endo
authors.forename: H
authors.initials: H
authors.lastname: Masuyama
authors.forename: T
authors.initials: T
authors.lastname: Hirabayashi
authors.forename: H
authors.initials: H
authors.lastname: Ikawa
authors.forename: J
authors.initials: J
authors.lastname: Yokoyama
authors.forename: M
authors.initials: M
authors.lastname: Kitajima
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D001656:Biliary Atresia / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011169:Portal Vein / Q000601:surgery; D011171:Portoenterostomy, Hepatic / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome