A group of specialist surgeons are focused on taking care of children with hepatobiliary problems, or problems with the liver, gallbladder or bile ducts. Bile ducts drain fluids and digestive enzymes from your liver to your intestine. This drainage is important both for your ability to absorb nutrients from your intestine and also for the health of your liver. Our team takes care of children with a wide variety of hepatobiliary problems. The two most significant biliary problems that can occur in children are biliary atresia and choledochal cyst. Both of these problems prevent the normal drainage of bile through these ducts but are treatable with surgery.
Biliary atresia is a progressive obliteration of the bile ducts from inflammation. The exact cause of biliary atresia is not known but it may be related to an immune response to an infection or in some cases the ducts may have never properly formed. Since bile from the liver can’t go through these ducts, it backs up in the liver and causes scarring and damage to the liver. Biliary atresia is usually first noticed by either a yellow color in the skin (jaundice) or a decrease of color of the stool (clay or white colored stools). If treated early, some infants with biliary atresia can be cured with a Kasai Procedure. Many others, however, despite having a Kasai operation, ultimately go on to have liver failure and will require a liver transplant.
Choledochal cysts are dilated or swollen areas of the bile ducts that prevent normal flow of bile through the duct. Patients are born with this cyst. Patients with a choledochal cyst may develop symptoms as an infant or as a teenager or any time in between. These symptoms usually include becoming jaundiced (yellow color of the skin or eyes) or having right upper abdominal pain and abnormalities in their liver enzymes. If a choledochal cyst is not removed, these patients have a higher incidence of developing cancers of the bile ducts later in life.
Our pediatric surgeons lead a multidisciplinary team which includes surgeons, gastroenterologists, and radiologists who take care of children with these disorders and make sure they get the best care possible for these conditions. Our team works to bring the most recent data and advanced techniques to the care of children with these problems.
Our hepatobiliary team is led by Dr. Tory Meyer and includes Dr. Michael Josephs, Dr. Julie Sanchez, Dr. Jeff Zweiner, and Dr. Jeb Baker.
Tory Meyer, MD, FACS
Dr. Meyer went to medical school at Columbia College of Physicians and Surgeons in New York and then did his general surgery and pediatric surgery fellowship in Cincinnati, Ohio. Training with Cincinnati Children’s notable hepatobiliary surgeons, Frederick Ryckman and Maria Alonso, Dr. Meyer developed a keen interest in taking care of babies with biliary atresia and other hepatobiliary problems. “With early recognition, favorable pathology, and careful attention to surgical technique many children with biliary atresia can do wonderfully and avoid a transplant for many years” says Dr. Meyer. He is the present Director of medical students for the Pediatric Surgery rotation and a Clinical Affiliate Faculty member at the Dell Medical School.
Michael D. Josephs, MD, FACS
Dr. Josephs attended medical school at Georgetown University in Washington, DC. He completed a general surgery residency at the University of Florida in Gainesville and subsequently did his pediatric surgery fellowship at Cincinnati Children’s Medical Center. Among his other surgical interests, Dr. Josephs has been focused on hepatobiliary surgery since he came to Austin nearly 20 years ago. “I think my emphasis on precise surgical technique as well as surgical innovation are well suited to hepatobiliary surgery.” Dr. Josephs has assisted in the development of a number of novel surgical devices in order to advance the care of children’s surgery. He is a Clinical Affiliate Faculty member at Dell Medical School and teaches surgical residents and students.
Julie I. Sanchez, MD, FACS
Dr. Sanchez is a long time Texan who went to Southwestern in Dallas for medical school. Her general surgery residency was at the Brooklyn campus of the State University of New York and her pediatric surgery fellowship was completed at Johns Hopkins in Baltimore. Dr. Sanchez has been taking care of the children of Central Texas for more than 20 years and has taken a special interest in those with hepatobiliary problems. She has the group’s largest experience in the care of children with choledochal cysts. “I am so honored to take care of our community’s children and I walk side by side with the parents through their journey until their child is healthy again.” Dr. Sanchez teaches medical students and residents and is a Clinical Affiliate Faculty Member at the Dell Medical School.
In addition, she has a special interest in caring for children with special needs. As a co-founder of Abilitee Adaptive wear, now Spoonie Threads, an online clothing company for children and adults with special needs, she embraces equality and inclusivity. She uses her surgical experience to help design and create adaptive clothing for children and adults. I believe in instilling a sense of fearlessness and confidence in children and parents by providing products that are fun, bright, and functional.