BACKGROUND/ PURPOSE: Kasai's operation consists of transection of the fibrous portal cord including the bile duct remnant. However, it is difficult to transect the fibrous cord at the level of the posterior surface of the portal vein, because the portal vein is fixed at the porta hepatis. METHODS: The authors described a new hepatic portoenterostomy to transect the fibrous cord under an appropriate visual field by division of the ligamentum venosum (Arantius' canal). Between February and December 1996, six patients who had biliary atresia underwent this procedure. RESULTS: Jaundice resolved completely (TB < or = 1.0 mg/dL) in all six patients within 40 days. Postoperative cholangitis did not occur and good bile drainage was obtained. CONCLUSIONS: Using this procedure, the portal vein becomes fully mobile after dividing the ligamentum venosum, and the porta hepatis can be widely exposed. The fibrous cord of the porta hepatis can be easily dissected off posteriorly and laterally.
BACKGROUND/ PURPOSE: Kasai's operation consists of transection of the fibrous portal cord including the bile duct remnant. However, it is difficult to transect the fibrous cord at the level of the posterior surface of the portal vein, because the portal vein is fixed at the porta hepatis. METHODS: The authors described a new hepatic portoenterostomy to transect the fibrous cord under an appropriate visual field by division of the ligamentum venosum (Arantius' canal). Between February and December 1996, six patients who had biliary atresia underwent this procedure. RESULTS:Jaundice resolved completely (TB < or = 1.0 mg/dL) in all six patients within 40 days. Postoperative cholangitis did not occur and good bile drainage was obtained. CONCLUSIONS: Using this procedure, the portal vein becomes fully mobile after dividing the ligamentum venosum, and the porta hepatis can be widely exposed. The fibrous cord of the porta hepatis can be easily dissected off posteriorly and laterally.