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Kasai procedure

Q:What is Kasai procedure (operation)?

The Kasai procedure (operation) is also called as porto-enterostomy.

This operation involves removing the blocked bile ducts and gallbladder from the liver and diverting bile from the liver into the child's own small intestine. Thus the bile from the liver directly flows into the intestine instead of the bile duct system.

 

Q:What are the situations where Kasai procedure is advised (Indications)?

Biliary atresia with neonatal jaundice.

Q:How will I benefit from this operation / procedure?

Without surgery, a child with biliary atresia is unlikely to live beyond the age of 2 years. After a successful Kasai procedure, the bile flow is restored, bilirubin normalises, child's oral intake improves and the stool gets its normal brown colour. These infants can be restored to good health and can lead a normal life without jaundice or major liver problems.


Q:What should I expect after the surgery?

After the operation, the child won’t be able to eat for 2-3 days after surgery, until the intestines recover from surgery. During this time, the child might need nutrition through an IV (intravenous line). After that, the child may be fed with breastmilk, special formulas and vitamins A, D, E, and K supplements by mouth. Sometimes, a small bore tube may be required, for a short period, if the child does not feed adequately by mouth.

The child may be given steroids for some time to decrease inflammation (irritation and swelling) of the bile ducts in the liver. They may also need antibiotics to prevent infection (cholangitis) caused by bacteria that travel from the intestines into the liver and bile ducts.

The child generally leaves the hospital in 7 - 10 days, and needs to be closely watched by doing blood tests, ultrasound and some other tests. The child should receive all prescribed immunizations and vaccinations against common diseases, including hepatitis A and B.


Q:What are the risks of this operation? What is the success rate of this operation?

Improvements in surgical techniques, anaesthetic and neonatal care have improved the outcomes of this operation, as long as early diagnosis is made, before permanent liver damage. About a third of children are expected to have a successful outcomes with significant improvement and resolution of jaundice.


However, if the liver disease worsens, they might develop symptoms of liver cirrhosis such as jaundice, itching, ascites (fluid in belly), unusual bruising or bleeding, frequent fever and poor growth. A third of children may slowly develop cirrhosis of liver, eventually needing a liver transplant to permanently correct this problem.


Unfortunately, the Kasai procedure may not always successfully restore the bile flow, in which case, the child may develop worsening liver disease and cirrhosis and require liver transplantation within the first 1 to 2 years of life.


The success of this operation depends on child's age, and is most successful in infants younger than two to three months of age. It also depends on the extent of liver damage (cirrhosis) at the time of surgery as determined by the liver biopsy and number and size of ducts in the scarred tissue that can drain bile as determined by the HIDA scan. Centers with surgical and medical teams with extensive experience in treating biliary atresia and performing Kasai procedure have higher success rates.