The Kasai procedure is considered the first-line treatment of biliary atresia.
Although it does not cure the condition, it can slow the progression of liver injury.
Surgery is the only reliable means to treat biliary atresia.
Jim Champion/ Flickr Creative Commons
What Is the Kasai Procedure?
The causes of biliary atresia are not clear.
For some children, this condition may occur because the bile ducts did not develop normally during pregnancy.
Other possible causes may include:
The Kasia procedure is aninpatient surgeryused in the first-line treatment of biliary atresia.
The Kasai procedure is performed as a matter of urgency.
Indications for Surgery
The Kasai procedure is performed upon the diagnosis of biliary atresia.
There are no contraindications for treatment.
Current research suggests that the three-year survival rate for untreated children is less than 10%.
With treatment, many children with biliary atresia can survive well into adulthood.
With the Kasai procedure specifically, there are other potential risks, including the following.
Purpose of the Kasai Procedure
The Kasai procedure is performed as soon as biliary atresia is diagnosed.
The surgery should not be delayed, as doing so can increase the risk of complications and treatment failure.
These procedures can all be performed within a matter of days.
Location
The Kasai procedure is performed in the operating room of a hospital.
Fasting helps prevent the risk ofpulmonary aspiration, in which food is accidentally vomited into the lungs.
Longer periods of fasting may be needed for children withdiabetes,cerebral palsy, orgastroesophageal reflux disease.
Medications
There are a few medications used in infants that can pose harm if taken before surgery.
The only exception is Advil (ibuprofen), which can be used in children over 6 months.
You should also bring your child’s favorite blanket, toys, or a pacifier to help comfort them.
Your child is then prepped for surgery either in a private or semi-private room or cubicle.
For the Kasai procedure, preoperative preparations will involve the following.
The anesthesiologist will also explain the anesthesia procedure and answer any questions you have.
Depending on whether the surgery is open or laparoscopic, the choices include the following.
Once the child has been anesthetized and vital signs are stable, the surgery can begin.
There are two major stages to the Kasai procedure: biliary duct resection and Roux-en-Y hepaticojejunostomy.
Once completed,surgical drainsare placed inside the incision and held in place by an anchor suture.
The abdominal wound is then closed with sutures or adhesive strips and bandaged.
Admission into theintensive care unit (ICU)may be needed, although this is less common today.
Nutrition will instead be delivered either through a nasogastric tube orintravenously.
Your child will likely be prescribed pain medications and antibiotics.
During this period, daily oral antibiotics will be prescribed to prevent cholangitis.
The treatment will likely be needed for a few months.
Treatment will likely be needed for several years.
Breastfeeding is typically recommended, since it provides types of fats that are easier for the liver to absorb.
Proper wound careis essential to ensuring a speedy recovery.
The follow-up evaluations mainly involve the following.
If the bile flow does not improveindicating treatment failureliver transplantation may be the only viable option.
This will typically be performed before the child’s second birthday.
Around 25% of children who undergo the Kasai procedure will survive into their 20s without needing a transplant.
There are several actors that may improve the long-term prognosis.
The outlook for children undergoing a liver transplant is good.
Prior to the introduction of the Kasai procedure, children with biliary atresia rarely survived beyond their third year.
Today, those who have undergone the procedure have been known to survive for 30 years with a transplant.
While jaundice is newborns is not uncommon, it usually resolves within five days.
Persistent jaundice is an entirely different issue and needs to be checked out immediately.
If biliary atresia is involved, early diagnosis and treatment almost always confer better results.
Dunn SP.Biliary atresia and biliary hypoplasia.
In: Shackelford’s Surgery of the Alimentary Tract, Volume 2 (Eighth Edition).
28(2):229-34. doi:10.1089/lap.2017.0535
Siddiqui AI, Ahman T.Biliary atresia.
10(1):e1-e6.
doi:10.4102/phcfm.v10i1.1582
Lakshminarayanan B, Davenport M.Biliary atresia: A comprehensive review.J Autoimmun.
2015;166(4):897-902.e1.
14(7):e19881.
17(37):4231-4. doi:10.3748/wjg.v17.i37.4231
Hofmann AF.Bile acid replacement in bile acid synthesis defects.J Pediatr Gastroenterol Nutr.
65(6):e134.
253(4):826-30. doi:10.1097/SLA.0b013e318211d7d8
Cincinnati Children’s Hospital Medical Center.Biliary atresia.
