Therapeutic problems in bile duct atresia

: Existence and patency of the intrahepatic bile ducts during the first weeks of age call for early surgery, before any further chance of active treatment will be lost due to obstruction. Every case of icterus persistent four to five weeks from birth should be an indication for laparotomy. Surgical treatment today is primarily characterised by hepatoportojejunostomy (Kasai II) and lymphodigestive shunt (Schweizer). 2 of 8 children survived five and seven years. All lethal courses had been due to progressive liver, cirrhosis and cirrhosis in conjunction with cholestasis. Hepatoportojejunostomy is considered to be the adequate surgical method. Lymphodigestive shunt is rejected as an exclusive approach and is accepted only when used in combination with hepatoportojejunostomy. Liver transplantation is likely to bear therapeutic promise in cases of insufficient shunt.