Modified Kasai's procedure for a choledochal cyst with
a very narrow hilar duct
Yoshiki Morotomi, Takuji Todani, Yasuhiro Watanabe, Takuo Noda, Kokichi
Otsuka
Pediatr Surg Int 11: 58-59, 1995
Excision has been widely recognized as the treatment of
choice for choledochal cysts. For biliary re-construction after cyst excision,
we have strongly recommended hepaticoenterostomy at the hepatic hilum with
a wide anastomotic stoma to prevent postoperative cholangitis. How-ever,
we recently treated two infants in whom a wide anastomotic stoma could not
be made due to a narrow hilar duct. Therefore, a hepatic portojejunostomy
with Roux-en-Y anastomosis (Kasai's procedure) was performed after cyst
excision in both case to permit free drainage of bile. The mucosa of the
hilar duct was everted and fixed to the liver parenchyma to prevent stricture
formation. Both babies have done well since the surgery.
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