[Treatment of extrahepatic bile duct atresia: Kasaï's operation or hepatic transplantation?].

The authors analyse the records of 60 children who had a failed Kasaï procedure and were referred for liver transplantation between 1984 and 1986. By the end of 1987, 45 had been transplanted, eight had died before transplantation, four had been excluded while three were still waiting for a potential donor. Actuarial survival at 2 and 3 years of the 30 children with a follow-up greater than one year is 79 +/- 8%. Nowadays, the surgical therapy of biliary atresia should include liver replacement. The original porto-enterostomy (one Roux-en-Y loop, no stoma) according to Kasaï should remain the first surgical procedure performed under 8 weeks by a trained surgeon. Good long-term results can be expected in 30 to 40%. In case of straight failure, liver replacement should be recommended in early age and, in case of delayed failure, before the age of 6 to avoid chronic disabling.