Hepatic Portocholecystostomy: 97 Cases From a Single Institution

OBJECTIVES:About 20% of cases of biliary atresia (BA) do not involve the gallbladder, the cystic duct and the common bile duct. In these cases, a hepatoportocholecystostomy (HPC) may be performed instead of the classical hepatoportoenterostomy (HPE). METHODS:We reviewed our cohort to investigate the efficacy of HPC as well as the associated surgical complications and clinical problems. RESULTS:From 1984 to 2009, 97 patients underwent HPC in our institution.In the first 6 months of the postoperative period no patient presented with bacterial cholangitis. Nine patients had bile leakage and one patient had a gallbladder obstruction. For these ten patients, HPC was modified in HPE. Jaundice clearance was maintained after HPE, but four of the patients presented one or more cholangitis episodes. After six months, there were no cases of cholangitis recorded, two patients presented bile leakage and four patients experienced gallbladder obstruction. After 5 years of follow up, 46% of the patients were jaundice free with their native liver and 29.4% were transplanted. CONCLUSION:In patients with BA with patent extrahepatic bile ducts, hepatoportocholecystomy is a good surgical technique that can prevent cholangitis. These results are counterbalanced by specific surgical complications that need to be known and looked for in the postoperative period.