BACKGROUND: Indications, results and limitations of portoenterostomy to treat biliary atresia in a referral pediatric hospital in Rio de Janeiro, Brazil, are discussed. METHODS: Eight patients were prospectively evaluated after being submitted to portoenterostomy (Kasai I) in a 3 years period (1997-2000). Seven of then operated by the same surgeon. All patients reserved to prophylactic antibiotics, oral choleretics and underwent a monthly follow-up for the first six months, and all of them were periodically submitted to laboratory, ultra-sonographic and endoscopid evaluations, following a pre-established schedule. RESULTS: We could obtain a stable biliary drainage for more than 6 post-operative months in 5 patients. There were 4 post-operative deaths (1 hepatic insuficiency, 1 cholangitis and 2 esophageal varices ruptures). All three patients with an insuficient biliary drainage died. Four of the five patients with a good and stable biliary drainage are anicteric and in good shape, one of them shows a serious residual hepatic fibrosis. We detected a generally late referral of patients and we could not obtain hepatic transplantation as necessary. CONCLUSION: Portoenterostomy is a satisfactory operation if we can obtain a satisfactory and stable post-operative biliary drainage. In cases without satisfactory biliary excretion quality of life is unsatisfactory and death occurs in the 2nd year, without hepatic transplantation. It is urgent to offer pediatric hepatic transplantation in a higher scale in Brazil and to educate doctors to send urgently icteric babies more than 15 days old to specialized units to be evaluated and treated precociously enough.
Biliary atresia; Portoenterostomy; Neonatal icterus; Kasai surgery
