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Updated: Aug 18, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
The portoenterostomy procedure for biliary atresia: a five year experience
Insights
The Kasai portoenterostomy surgery improves bile drainage in infants with biliary atresia. Early intervention offers favorable outcomes for about 50% of infants, though progressive liver disease remains a concern.
Area of Science:
- Pediatric Surgery
- Hepatology
- Gastroenterology
Background:
- Biliary atresia is a historically fatal disease in infants.
- The portoenterostomy (Kasai) procedure has significantly improved patient outlook.
- Early diagnosis and surgical intervention are critical for managing biliary atresia.
Purpose of the Study:
- To evaluate the long-term outcomes of the Kasai portoenterostomy procedure in infants with biliary atresia.
- To determine the correlation between ductal histology and postoperative results.
- To assess the efficacy of surgical treatment in modifying the disease process.
Main Methods:
- Retrospective analysis of 37 infants undergoing portoenterostomy (Kasai procedure) between 1972 and the study period.
- Diagnostic operative cholangiography and liver biopsy for suspected obstructive jaundice.
- Portojejunostomy or portocholecystostomy based on intraoperative findings of ductal patency.
Main Results:
- Bile drainage achieved in 26 of 37 patients (70%).
- Seventeen patients (46%) showed near-normal growth and development postoperatively.
- Progressive hepatic fibrosis was observed in 14 patients despite bile drainage, indicating multifactorial disease progression.
Conclusions:
- The Kasai portoenterostomy can achieve bile drainage and improve outcomes in a majority of infants with biliary atresia when performed before three months of age.
- Histological examination of ductal tissue correlates with surgical outcomes.
- Extrahepatic biliary atresia is a dynamic process, and early surgical treatment can favorably modify the disease in approximately 50% of cases.
Abstract:
The portoenterostomy (Kasai) procedure in infants with biliary atresia has dramatically altered the outlook for this heretofore fatal disease. When performed on infants under three months of age, bile drainage can be achieved in a majority of the patients. Since 1972, 37 infants have been treated with this operation at our institution. Diagnostic operative cholangiography and liver biopsy are recommended if the cause of conjugated hyperbilirubinemia is presumed to be obstructive. When biliary atresia is encountered, identification of the atretic ducts with transection high in the porta hepatis is carried out. Thirty-two infants have had the portojejunostomy, while five, in whom the proximal hepatic ducts were atretic but the gall bladder and distal ducts were patent, underwent portocholecystostomy. Examination of the resected fibrous duct tissue revealed a statistically significant correlation between ductal histology and postoperative outcome. Extended bile drainage has been achieved in 26 of 37 patients. Seventeen exhibit near normal growth and development four months to five years postoperatively. Seven have died with progressive liver disease despite bile drainage. Two additional patients died, jaundice free, from unrelated causes. Despite bile drainage, progressive hepatic fibrosis has been confirmed by serial biopsies in 14 patients. This finding indicates that biliary obstruction is not the sole component in the development of biliary cirrhosis. These data suggest that extrahepatic biliary atresia is a dynamic obliterative process, which can be favorably modified in approximately 50% of the infants by early surgical treatment.
