Indication for portoenterostomy based on 103 patients with Suruga II modification

Although the prognosis of biliary atresia has greatly advanced, only two thirds of patients are able to survive for a long time. This study was designed to investigate the correlation between liver fibrosis, size of ductuli at porta hepatis, and prognosis in order to determine the indications for the Kasai operation. The results of this study showed that the more severe fibrosis of the liver becomes, the worse will be the postoperative clinical features, and the larger the size of ductuli at porta hepatis, the better the prognosis. Based on these results, we have concluded that it is often possible to predict the prognosis at radical surgery by evaluating frozen sections. Patients can be divided into three groups according to these histological findings: group 1 (correctable, or RI in F1); group 2 (RII in F1, RI or RII in F2); group 3 (RIII, RI, or RII in F3). Although the Kasai operation is definitely indicated for patients in groups 1 and 2, making a stoma should be avoided in group 2, because the possibility of liver transplantation may arise in the future. Meanwhile, there is no indication for the Kasai operation for the patients in Group 3, liver transplantation is recommended.