The liver has ducts, so that the bile it produces can drain into the intestine and help with digestion of food. If these ducts are blocked, the Kasai procedure is a way to surgically bypass them and prevent liver damage. It is often the preferred treatment for biliary atresia.
To perform the Kasai procedure, surgeons first carefully remove the damaged ducts outside of the liver. They use a small segment of the patient's own intestine to replace the ducts at the spot where bile is expected to drain. This segment not only connects to the liver, but also connects to the rest of the intestine. The Y-shaped passageway formed by the Kasai procedure allows bile to flow from the liver into the intestine.
If your child needs a Kasai procedure, he or she will usually spend seven to ten days recovering in the hospital. During this time, the Kasai will heal, and doctors will give your child medications to prevent ascites, or excessive fluid build-up. In the long-term, antibiotic therapy helps reduce the risk of infection entering the liver through the intestine. Although Kasai procedure is not a permanent cure for biliary atresia, in many cases it allows patients to grow and remain in good health for several years.
This delays (or in about 25% of children, eliminates) the need for a liver transplant. When the Kasai procedure is done at an early age (younger than three months), about 80% of patients have some bile flow. In nearly 30% of those infants, enough bile is able to drain from the liver that bilirubin levels return to normal. In the smaller number of patients who don't benefit from the operation, some of the obstructed bile ducts are inside the liver as well as outside. When this happens, liver transplantation is needed sooner to correct the problem.
The Kasai procedure involves removing the blocked bile ducts and gallbladder and replacing them with a segment of your child's own small intestine. This segment of intestine is sewn to the liver and functions as a new extrahepatic bile duct system.
The operation will be performed by a Pediatric Surgeon who has had special training in the management of surgically correctable problems in children. The surgeon may be able to operate through many small incisions (laparoscopic surgery) instead of one large (open surgery) incision. The surgeon will determine the safest method of operating and will discuss this with you before the procedure takes place. The operation will take approximately 4 hours to complete.
What are the possible outcomes for patients after a Kasai procedure?
Normal restoration of bile flow and recovery of liver function occurs in approximately one third of children who undergo the Kasai procedure. These children may not require liver transplantation. The remaining two thirds of children who undergo the Kasai procedure will not have adequate bile flow and liver function, and will eventually require liver transplantation. Of this group, half will need transplantation soon after the Kasai procedure and half will need transplantation at a later time.
After the operation, your child will be cared for in the recovery area, and you can be with him or her while he or she is waking up. From the recovery room your child will be transferred to the pediatric floor and will stay in the hospital for several days. Once your child is able to eat well, has no fever, and is comfortable on pain medication by mouth, he or she will be discharged home.
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