title: Surgical management for intractable cholangitis in biliary atresia.
abstract: 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.
authors.affiliation: Department of Surgery, Kobe Children's Hospital, Kobe, Hyogoken, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Muraji
authors.forename: Chikara
authors.initials: C
authors.lastname: Tsugawa
authors.forename: Eiji
authors.initials: E
authors.lastname: Nishijima
authors.forename: Shiiki
authors.initials: S
authors.lastname: Satoh
authors.forename: Shigeru
authors.initials: S
authors.lastname: Takamizawa
authors.forename: Kazuya
authors.initials: K
authors.lastname: Ise
authors.forename: Takayo
authors.initials: T
authors.lastname: Maekawa
mesh_terms: 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