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Friday, April 30, 1999 Published at 13:19 GMT 14:19 UK


Health

Specialist centres to perform rare liver operations

Biliary atresia is a rare condition

A complex operation for a rare life-threatening liver condition is to be restricted to three specialist centres, Health Secretary Frank Dobson has announced.

The statement follows concern that some children with the condition biliary atresia were dying unnecessarily because they were being operated on by doctors who were not experts in the field.

The BBC programme Trust me I'm a doctor claimed earlier this year that operations carried out at local hospitals instead of specialist centres were more than three times less likely to be successful.

If they fail, the only other resort is a liver transplant which can be risky for very young children.

Without any treatment, children with biliary atresia usually die before reaching their second birthday.

The operation needed to correct the condition is known as a Kasai poroenterostomy.

Specialist centres

Mr Dobson said the government had accepted the recommendation of the National Specialist Commissioning Advisory Group to restrict the operation to King's College Hospital in London, Birmingham Children's Hospital and The Leeds Teaching Hospitals.

King's College and Birmingham specialise in paediatric liver disease operations.

The Leeds' paediatric liver team will be developed over the next year to be able to specialise in the Kasai portoenterostomy procedure.

Mr Dobson said the decision had been taken after information showed that outcomes improved if patients were operated on in centres which performed a larger number of the procedures.

He also announced that the centres would be subject to an independent audit to ensure that they produce the best possible results for the operation.

Welcome news

The Children's Liver Disease Foundation (CLDF) charity, which has been campaigning for years to improve treatment of biliary atresia, welcomed the announcement.

Chief executive Catherine Arkley said: "We are obviously delighted that all children diagnosed with biliary atresia, regardless of where they are born, will now be offered the best possible change of a healthy life.

"However, we need to remember that when this procedure was previously designated to two centres several years ago, surgeons at some regional hospitals continued to perform the operation.

"We hope that with the designation of the service to three centres, the operation will be confined solely to these units."

The CLDF's research shows that hospitals that only carried out one Kasai operation a year had a 17% success rate, compared with a 64% success rate for those performing five or more operations.

In 1985, the government opted to designate specialist centres for treating children with biliary atresia.

But in 1995, it reversed this decision. It says this change of mind was based on advice from the Royal College of Surgeons.

The College and the British Association of Paediatric Surgeons both now support the use of expert centres.

Around 50 babies in England and Wales are born with biliary atresia each year.

It means the tiny bile duct to their liver is blocked and poisons build up, causing jaundice.

The Kasai portoenterostomy operation stands a greater chance of success if performed within eight weeks of birth.

It involves taking a loop of intestine and forming it into a pipe to drain the bile from the liver.



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26 Feb 99 | Health
Liver disease babies dying 'needlessly'

26 Feb 99 | Medical notes
Biliary Atresia: The facts





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