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Congenital Biliary Atresia-Reply

AKIO KOBAYASHI, MD
Am J Dis Child. 1977;131(7):816. doi:10.1001/archpedi.1977.02120200096025.
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In Reply.—Now, for the first time, I have read the article by McCarry and Pence.1 The procedure described by the authors was to create a satisfactory fistula between one portion of the liver and the intestinal tract by making a stab wound through the hepatic attachment of the gallbladder deep into the liver parenchyma and anastomosing the gallbladder to the intestine. However, the surgical procedure was quite different from those of Longmire and Sanford2 and of Kasai et al;3 especially, the operation reported by Kasai et al3 was reasonable, safe, and acceptable to many pediatric surgeons. On the other hand, the procedure used by McCarry and Pence was very dangerous and not always successful, although, fortunately, in their patient bleeding during surgery was very scanty and good bile flow was obtained. It is probably for these reasons that no further efforts were made along these

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