Influence of diversion on the development of cholangitis after hepatoportoenterostomy for biliary atresia.

This study was undertaken to determine if the incidence of cholangitis is reduced when external diversion is added to hepatoportoenterostomy for biliary atresia. Nineteen children undergoing hepatoportoenterostomies without diversion between 1975 and 1984 were compared with 12 children who had hepatoportoenterostomies with diverting jejunostomies. Patient data were analyzed for the episodes and severity of cholangitis and other factors known to influence the outcome of biliary atresia. The groups were similar with regard to age of patient at the time of operation, degree of liver damage on biopsy, and the establishment of bile flow after hepatoportoenterostomy. There was no difference in the incidence of cholangitis between the nondiverted (32%) and the diverted (33%) groups. However, the addition of external diversion increased the morbidity and mortality. Four patients with diversion required surgery for bleeding, prolapse, or retraction of the jejunostomy, and two additional patients died as the result of stomal complications. External diversion does not decrease the incidence or severity of cholangitis after hepatoportoenterostomy, but significantly increases the risk of severe and fatal complications.