Am J Surg 1981 Jan;141(1):57-60

Prognostic determinants after hepatoportoenterostomy for biliary atresia

Weber TR, Grosfeld JL, Fitzgerald JF

Abstract
Hepatic secretory functions were measured postoperatively in 17 infants
undergoing hepatoportoenterostomy for biliary atresia. These studies were
compared in surviving and nonsurviving infants to attempt early identification
of infants who might require reoperation. Statistically significant differences
between surviving and nonsurviving infants were found in alkaline phosphatase
clearances at 1, 4, 12 and 24 weeks postoperatively. In addition, bilirubin
clearance and secreted 24 hour bilirubin measurements were significantly
increased in survivors 12 and 24 weeks postoperatively. Iodine-131 rose bengal
excretion, measured 6 months postoperatively, was likewise significantly
increased in survivors. Six of the 10 surviving infants required reoperation
when their secretory functions deteriorated; all improved postoperatively. None
of the seven nonsurviving infants underwent reoperation. Biliary secretory
functions have early prognostic significance and apparently can predict which
infants require reoperation. Reexploration and higher transection of atretic
ducts may improve survival