Improved weight gain following closure of exteriorized conduit for biliary atresia

Accelerated weight-gain velocity was observed in five infants with extraheptic biliary atresia following closure of the exteriorized conduit. Despite excellent bile drainage (daily volumes 150–900 ml) and refeeding of this fluid to the efferent limb, steatorrhea occurred in three patients and was suspected in the other two. Total bile-acid concentrations in the bile collected prior to refeeding into the jejunum were below the critical micellar concentration in most of the specimens tesred. The nutritional consequences of bile diversion need to be balanced against the beneficial effects in diminishing the incidence of postoperative cholangitis. We postulate that fat malabsorption occured in these children because of inadequate bile-acid concentrations and inefficient fat emulsification. Bile acids were normally conjugated with glycine and taurine.Offprint requests to: J. Levy