The application of Kasai's portoenterostomy procedure for infants with extrahepatic biliary atresia has modified the outlook for this formerly hopeless condition. When perfomed before the age of 3 months, bile drainage can be anticipated. Since 1972, 48 infants have had the portoenterosty procedure at Children's Hospital National Medical Center, Washingon, D.C. the operative results are summarized in this report.

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Since 1959, when Kasai and Suzuki (1) devised hepatic portoenterostomy to correct extrahepatic biliary atresia, evidence of restoration of bile flow had been obtained in approximately 40 to 60% of patients operated on before 4 months of age. Among the postoperative complications observed in these patients, portal hypertension becomes a frequent finding in all series with a long follow-up. Its development has been related to an ongoing biliary cirrhosis and frequent attacks of postoperative cholangitis. We have recently reviewed this problem in a series of 34 patients who displayed some degree of restoration of bile flow for at least one year after surgery.

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The results of treatment of congenital biliary atresia (CBA) have been remarkably improved in recent years, and there are many reports of survivals without jaundice after surgery. However, it has become clear that the prognosis of these survivors was not always good and that, in spite of establishment of bile flow, a liver cirrhosis and a portal hypertension developed in quite a few patients who died of hepatic failure or variceal rupture. The purpose of this paper is to report the results of the long-term follow-up study after radical operation for CBA.

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In this presentation I would like to talk on our long term results of biliary atresia. This report primarily concerns five patients in whom a supplementary operation was performed, and this is also a report mentioned about seven patients who are surviving more than five years after hepatic portoenterostomy.

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Kuwait should be congratulated on the establishment of a neonatal and paediatric surgical unit, because already a vigorous attempt has been made to provide basic medical care and a good public health section. The high birth rate, high proportion of people under 15 years of age, and rapidly growing population makes the presence of skilled paediatric surgical services essential. There is a high incidence of congenital anomalies especially in certain diseases, possibly genetic in origin, which requires the establishment of a paediatric surgical service to study and deal with these problems. The volume of work and clinical material admitted to the unit in the first year after its inception shows that there is great potential for further development.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Pneumatosis intestinalis and hepatic portal venous gas were observed in a premature infant with necrotizing enteritis secondary to the ileal stenosis due to peritoneal adhesions after the ileostomy. The infant survived but developed an ileal stricture nine months later and a plastic operation was performed. Although the lesion seen at initial operation was not decided hastly as a preceding lesion of neonatal necrotizing enterocolitis, the histopathological findings of the ileum showed rather stagnant than ischemic circulatory disturbance. A surgically corrected intestinal stricture subsequent to necrotizing enterocolitis has been reported in Japanese literature, late complications such as intestinal stricture and internal fistula should be considered with an increasing number of surviving infants.

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A case of rare type of esophageal atresia, and a new technique of esophageal elongation for the repair of esophageal atresia were reported. The patient was a mature male infant with esophageal atresia that was initially diagnosed as "Gross type B" by upper esophagography. However, he had an isolated esophageal cyst with tracheal fistula beneath the upper esophageal pouch. we, in the present case, successfully repaired the long gap type of esophageal atresia without using bowel segment to bridge the esophageal defect, but with Lafer's procedure followed by our new technique; continuous compression using ballown catheter inserted into the lower esophageal pouch. Then, operation with Rivaditis' circular myotomy was applied.

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