[How to improve the results of treatment of biliary atresia]

In the present article, strategies on how to improve the clinical results of patients with biliary atresia are discussed. Our policies include 1) meticulous and accurate dissection and enteric anastomosis at the porta hepatic with the use of hepatic mobilization, 2) use of a complete external biliary fistula (Sawaguchi method), 3) use of an intussusception-type anti-reflux valve in the Roux-en-Y limb, 4) prompt reoperation if necessary, 5) prolonged use of antibiotics and choleretics, 6) in-patient care for as long as 3 months after hepatic portoenterostomy, etc. 19 of 21 patients, treated at National Children's Hospital and University of Tokyo, became jaundice-free, and we conclude that these policies mentioned above are necessary to keep the jaundice-free ratio at 90%, not at 70% which is the average ratio at all Japanese institutions.