"Uncorrectable" extrahepatic biliary atresia: relationship between intrahepatic bile duct pattern and surgery

Postmortem examination of intrahepatic bile ducts in the vicinity of the porta hepatis was performed in 26 patients. Fifteen of them (group I) had resection of fibrous remnants with or without biliary-intestinal anastomosis, and the remaining 11 (group II) had had exploratory laparotomy only or were not operated at all. The mean age at death was 10 and 7 1/2 mo, respectively, for each group. In group I, the diameter ranged from 1.5 to 15.0 mm (mean:5.23); the duct was dilated and contained bile concretions. In group II, the diameter of bile duct ranged from 0.2 to 1.2 mm (mean:0.63); the duct appeared flattened and its lumen was empty. Because a similar difference was observed in the patients of either group who died at 4 to 8 mo of age, previous surgical section of fibrous remnants may be responsible for enlargement of the intrahepatic bile duct. Whether section of nerves plays a role in this process remains to be determined.