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As reported in 1974, the initial experience at the Oklahoma Children's Memorial Hospital with the Kasai procedure for biliary atresia was unsatisfactory. A subsequent series of 20 patients, in which 50% of the patients are alive and improved and 25% jaundice-free, is described. Modifications of the initial operative technique have been utilized. Postoperative complications in the ten children with sustained bile flow included cholangitis in five, hyponatremia in four, esophageal variceal hemorrhage in two, stomal bleeding in two, and gallbladder conduit malfunction in two patients. The improved outcome is attributed to earlier diagnosis and correction, attention to operative details, intensive postoperative nutritional support, and prompt recognition and management of complications.

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