Surgical management for intractable cholangitis in biliary atresia.
OBJECTIVE
The efficacy of antireflux surgical procedures involving the Roux-en-Y jejunal limb for cholangitis was evaluated retrospectively in patients with biliary atresia (BA).


METHODS
From July 1993 to December 2001, 41 patients with BA underwent hepatic portojejunostomy with Roux-en-Y reconstruction. Of these patients, 11 had intractable cholangitis that was treated by creation of a value with or without lengthening of the Roux-en-Y limb.


RESULTS
Among the 11 patients, the first episode of cholangitis occurred within 6 months after portojejunostomy in 10 patients and at the age of 4 years in one patient. Cholangitis developed at various intervals from once every week to once every 2 months requiring hospitalization each time. All patients underwent valve creation at 2 months to 5 years postoperatively, whereas 2 had an additional lengthening of the limb. Cholangitis resolved completely after surgery in all cases. Two patients underwent liver transplantation, and the third patient died of an unrelated cause. The 8 survivors with native livers are doing well after 1 to 8 years of follow-up.


CONCLUSIONS
Early surgical intervention could control intractable cholangitis in all patients, both delaying the time of liver transplantation and improving the quality of life.
Muraji
Toshihiro
T
Department of Surgery, Kobe Children's Hospital, Kobe, Hyogoken, Japan.
Tsugawa
Chikara
C
Nishijima
Eiji
E
Satoh
Shiiki
S
Takamizawa
Shigeru
S
Ise
Kazuya
K
Maekawa
Takayo
T
D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D001656:Biliary Atresia / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D002761:Cholangitis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007582:Jejunostomy / Q000009:adverse effects; D016031:Liver Transplantation; D008297:Male; D011788:Quality of Life; D012189:Retrospective Studies