Anatomy of the porta hepatis (PH) as rational basis for the hepatoporto-enterostomy (HPE).

PURPOSE

In a prospective study it was investigated whether and to what degree the morphology of the porta hepatis has a bearing on the early prognosis of children with EHBA. The results will point to consequences of surgery and to the formulation of a rational understanding of the successes and failures of HPE.

METHODS

The macroscopy and the microscopy of the liver was studied on native specimen and corrosion preparations of deceased adults, children and embryos. The area potentially draining the bile was determined in excised PH specimen of children with EHBA. The histologically and planimetrically measured areas were correlated to clinical follow-up studies. In order to be able to study exclusively the influence of the PH morphology, the conditions of the intrahepatical structural changes (level of fibrosis, metric and morphic changes of biliary ductules in the Glisson's triads) had to be equal. Under these conditions 61 excised PH specimen were evaluated. The level of fibrosis was determined according to the definition of Schweizer/Müller 1984 (9).

RESULTS

1. Biliary ductules of the PH end in three definable zones according to a regular pattern. 2) Biliary ductules of the PH run in a narrow and immediate relation to the vascular structures. 3) Biliary ductules of the PH are often hidden between the vascular structures of the PH and are not always accessible to preparatory exposure for the anastomosis. 4) The quantity of the bile flow is a significant function of the total area of the biliary ductules secured in the excised PH specimen. 5) Incised biliary ductules at the excision edge may be obstructed again in the scarring of the anastomosis, leading to an early interruption of bile flow. 6) The opening-up of the biliary ductules in the central zone alone is not enough to guarantee a permanent bile flow. Only if intact biliary ductules of the two lateral hepatical lobes are secured, can a positive prognosis be made.