BACKGROUND/PURPOSE: Progressive @entity9744 ( @entity11762 ) is often characterized by @entity111 -induced self-mutilation with minimal response to medical therapy. The causative @entity1448 is likely to progress to @entity82 necessitating transplantation. Partial external biliary diversion has been used with promising results for the @entity1087 and debilitating @entity111 but all the potential complications and aesthetic concerns of long-term stomas attend this approach. METHODS: The authors describe a terminal ileal exclusion that was first developed for @entity1 who had previously undergone cholecystectomy. Over a 3-year period, we identified for study seven @entity1 with liver histology characteristic of @entity11762 accompanying a clinical picture of chronic @entity1448 without a defined metabolic or anatomic abnormality. The first two @entity1 underwent a cholecystojejunal cutaneous stoma, until now, the recommended treatment for this condition. The third had previously undergone cholecystectomy so an ileocolonic @entity254 was performed excluding the distal 15% of the small bowel. This @entity1 had complete relief of @entity111 without evidence of @entity294 . Two more terminal ileal exclusions were performed with similar results before standardizing this approach. The authors approximated small intestinal length using Siebert's graph relating crown-heel length to small intestinal length. The midpoint between the mean and one standard deviation below the mean was determined. Fifteen percent of the estimated small bowel length was measured back from the ileocecal valve and then divided using a linear stapling device. A stapled @entity254 was created between the proximal ileum and the cecum, bypassing the terminal ileum. RESULTS: Four of five @entity1 have had relief from their @entity111 and self-mutilation with no evidence of @entity294 . Terminal ileal bypass offers a stoma-free, completely reversible "biliary diversion." CONCLUSION: Early results on a few @entity1 are promising, but long-term evaluation of growth, development, and liver function and histology is needed before advocating this as the primary therapy for @entity11762 .

Ileal exclusion for XXXX : an alternative surgical approach with promising early results for @entity111 .

@entity1 :: ('9606', 'Species') :: ['children', 'patients', 'child'] @entity82 :: ('MESH:D005355', 'Disease') :: ['cirrhosis'] @entity1087 :: ('MESH:D007565', 'Disease') :: ['jaundice'] @entity254 :: ('MESH:C563598', 'Disease') :: ['anastomosis'] @entity294 :: ('MESH:D003967', 'Disease') :: ['diarrhea'] @entity111 :: ('MESH:D011537', 'Disease') :: ['pruritus'] @entity1448 :: ('MESH:D002779', 'Disease') :: ['cholestasis'] @entity11762 :: ('MESH:C535933', 'Disease') :: ["Byler's disease"] @entity9744 :: ('MESH:D002780', 'Disease') :: ['familial intrahepatic cholestasis']
@entity11762 :: (MESH:C535933,Disease) :: ['Byler's disease']
