Prognostic determinants after hepatoportoenterostomy for biliary atresia.

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.