[Current state of the treatment of congenital biliary atresia]

Current state of the treatment of biliary atresia was studied concerning following factors based on our experience of 240 patients during 1966 to 1988, particularly 103 patients who received Kasai operation with Suruga II modification. 1. Operative results: Overall and Suruga II. 2. Predictable factors of the prognosis at the first radical operation, especially, among the age, the hepatic fibrosis and the size of ductuli at porta hepatis. 3. Technical refinement of Kasai operation, especially concerning the exposure of portal area and the anastomosis. 4. Our recent device of modified Kasai operation, that is, hepatic portoduodenostomy with interposition of ileocecoappendix. 5. Rehepatic portoenterostomy in case of poor postoperative bile flow. From our experiences, Kasai operation is indicated to the patients who have mild or moderate liver fibrosis and good sized ductuli at porta hepatis, but not to the patients who have advanced liver fibrosis and extremely poor ductuli. In such circumstance, liver transplantation should be considered. Rehepatic portoenterostomy is only indicated to the patients who have a good bile flow after the initial Kasai operation but not to the patients who have no bile flow.