Abstract
This chapter presents a series that describes the early outcome of a national policy change in the management of biliary atresia (BA) from a decentralised one based on regional neonatal surgical centres to one based on specialist hepatobiliary centres co-locating facilities for the Kasai operation and liver transplantation. One hundred forty-eight infants with BA were treated between January 1999 and June 2002. The outcome of management of BA has been a subject of great scrutiny, out of all proportion to its actual frequency in the population. Centralisation as a concept can of course be applied to other aspects of surgery, specifically paediatric surgery, where the cases are usually few and far between and surgical expertise and experience makes a difference to outcome. In the United Kingdom, this strategy has been adopted for the management of bladder exstrophy with many also calling for the management of long-gap and isolated oesophageal atresia to be restricted to only a few centres.