Reconstruction of intrahepatic bile ducts in congenital biliary atresia

Macroserial reconstruction of the main intralobular bile ducts was made in 7 cases of biliary atresia; 2 cases of type I, 1 case of type II and 4 cases of type III according to Kasai's classification. From the results of these reconstruction studies, it was confirmed that the main interlobular bile ducts are usually patent through the liver regardless of the type of atresia of the extrahepatic bile ducts. A microserial reconstruction of bile ducts and ductules of a small portal tract performed in one case disclosed that a number of ductules make a network around the main duct and have some communications with the main duct. These results were compatible with the fact that active excretion of bile was obtained in many postoperative patients with biliary atresia. As observed in one case of the present series, postoperative complication of severe ascending cholangitis seemed to be an important cause of destruction or disappearance of intrahepatic bile ducts, which has also seen in older infants with this disease without complicaion of cholangitis. In view of these facts the operation of an early stage of life is recommended in biliary atresia.