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Ten patients with surgically correctable extrahepatic biliary atresia have undergone surgical biliary-enteric drainage at the UCLA Hospital during the past 16 years. During the same period, 39 additional patients underwent biopsy or other operative procedures for intrahepatic atresia. Three categories of “correctable” atresia are identified: Type A with a large cystic dilatation of the proximal duct; Type B with a moderately dilated proximal common duct measuring 4 to 12 mm. in diameter; and Type C with a blindly ending proximal duct less than 3 mm. in diameter. The prognosis for long-term survival with resolution of cirrhosis is good in patients with Types A and B atresia, provided biliary-enteric drainage is established before the age of four months. Five of the eight patients in the present study who underwent biliary-to-intestinal anastomosis before the age of four months are still alive and well. Choledochojejunostomy is less likely to be complicated by obstruction or cholangitis than is drainage to the duodenum. Patients with Type C atresia may occasionally benefit from jejunal anastomosis to the hepatoduodenal ligament if performed before the age of three months. A few patients may have a combination of intrahepatic and extrahepatic atresia.
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Accepted: October 10, 1973
☆Supported by the United States Public Health Service Grant No. HL 14333.
☆☆Presented at the Sixth Annual Meeting of the Pacific Association of Pediatric Surgeons, San Diego, Calif., April 18–20, 1973.
© 1974 Published by Elsevier Inc.