Effects of hepatic periarterial neurectomy (HPN) on the treatment of biliary atresia.

Thirty one patients with biliary atresia have undergone Kasai's operation in our clinic during the past 10 yr. Three of the patients died from postoperative complications. Of 12 patients who underwent Kasai's operation only five (41.7%) showed good excretion of bile. Two of them, 16.7%, have survived without jaundice for more than 8 yr. Of 16 patients who underwent hepatic periarterial neurectomy (HPN) combined with hepatic portoduodenostomy, 11 (68.8%) showed good bile excretion. Seven of them, 43.8% are alive and well for period between 6 mo and 5 yr 6 mo postoperatively. Although improvement in the technique for boring the porta hepatis may have contributed to these good results, we think that the addition of hepatic periarterial neurectomy to Kasai's operation gives even better results. According to our experimental studies, hepatic periarterial neurectomy resulted in increased bile flow in the early postoperative period and thus seemed to be of value in preventing postoperative ascending cholangitis.