Response to the Letter to the Editor on Biliary Atresia and Inguinal Hernia

Thanks for giving us the opportunity to reply to the letter of Joob and Wiwanitkit.[1]

The authors state that no case of inguinal hernia was found in a “large series” that they have recently reported.[2] Unfortunately, first we have to dispute the accuracy and veracity of their work given their apparent confusion on what a Kasai operation is intended for: “Kasai operation…is primarily proposed as a surgical correction technique for choledochal duct cyst.” Second, their “review” is actually based on a simplistic interpretation of four entirely separate articles from different Thai centers published between 1994 and 2006.[3] [4] [5] [6] Not one of these series was ever designed to answer the central question we posed concerning the association of biliary atresia (BA) with inguinal hernia.

The lack of any hernia in a series of 200 infants and children is in itself remarkable, regardless of the presence of an underlying pathology.

We look forward to others confirming or disproving the association between BA and inguinal hernias but this Thai “review” does not do either.

• References

• 1 Joob B, Wiwanitkit V. Biliary atresia and inguinal hernia. Eur J Pediatr Surg 2012; . In press
• 2 Joob B. Kasai operation: a summary on Thai experience. Diag Ther Stud. 2012; 1: 52-53
• 3 Ngamjunyaporn K, Pruksananonda C, Chandrakamol B , et al. Growth and development of pediatric patient after Kasai operation. Thai J Pediatr 2000; 39: 72
• 4 Ngamjunyaporn K. Growth and development of pediatric patient after Kasai operation. Thai J Pediatr 2000; 39: 97-106
• 5 Namhom S. Partial splenic embolization in post Kasai's hypersplenism: a preliminary report. Thai J Surg 1994; 15: 64-65
• 6 Sookpotarom P, Vejchapipat P, Chittmittrapap S , et al. Short-term results of Kasai operation for biliary atresia: experience from one institution. Asian J Surg 2006; 29 (3) 188-192