Abstract
In Japan, it has been considered that serum bilirubin (T.bil.) less than 2.0mg/dl after radical operation of biliary atresia (BA) means 'jaundice-free'. To assess the right jaundice-free level, 27 patients (operated from 1977 to 1993) whose T.bil. were less than 2.0mg/dl, were reviewed. They were divided into two groups according to bilirubin level, group A (T.bil.<1.0mg/dl, n=15) and group B (1.0≦T.bil.<2.0mg/dl, n=12). The occurrence of the cholangitis was not significantly different in two groups. The recurrent and prolonged jaundice was recognized in two patients in the group B, whereas none in the group A. The patients in the group B had significantly higher levels of serum transaminase (p<0.01). γ-GTP (p<0.05), and T. B. A. (p<0.05). The grade of esophageal varices were significantly higher in the group B (p<0.01). The association of the hypersplenism was not significantly different, but both two severe cases received PSE or splenectomy belonged to the group B. From these results it was considered that there would be significant differences in clinical outcome between the two groups. Therefore the patients who have higher bilirubin level than 1mg/dl should be observed more carefully, and it would be necessary to reconsider the serum bilirubin level for 'jaundice-free'.
