[Reoperation in biliary atresia].

From July 1976 to February 1988 52 cases of extrahepatic biliary atresia were treated at our institution and 16 patients underwent reoperation. The original procedure were portojejunostomy in 11 cases (68 for 100), portocholecystostomy in four (25 for 100) and omento-duodenopexy in one (6 for 100). Age average at operation was 61 days; twelve had bile excretion. The reoperation was performed due to absence of bile drainage in three cases, cholangitis in 9 and bile peritonitis in four. Surgical procedures used at reoperation were: excision of scar tissue at the porta hepatis (12 patients) and portojejunostomy (five patients). Age average at reoperation was 105 days. Seven cases excreted bile. Liver pathology studies showed fibrosis in 12 cases and precirrhosis in four. The porta hepatis showed biliary ducts less than 100 mu in 10 cases, between 100mu-200mu in two, and absence of bile ducts in four. Currently four children are doing well with a mean long-term follow-up of 48 months, five are awaiting liver transplantation and one patient is doing well sixteen months post-transplant. Six patients (38 for 100) died. The best results were observed in those cases with early bile flow excretion after the first operation.