Kasai Procedure

What is the Kasai procedure?

The Kasai procedure is a surgical treatment for biliary atresia. During the Kasai procedure, your baby’s provider will remove the blocked bile ducts outside their liver. They’ll use a portion of your baby’s small intestine to create a new pathway for bile to drain out of their liver. Other names for the Kasai Procedure are hepatoportoenterostomy, biliary atresia surgery and biliary atresia operation.

What is the Kasai procedure used for?

Kasai surgery can slow — and sometimes stop — the progression of biliary atresia. Healthcare providers usually diagnose babies with biliary atresia within the first two months of life. If your baby has the condition, a blockage in their bile ducts stops bile from flowing into their bowel. The blocked bile damages and scars their liver cells (cirrhosis).

If untreated, biliary atresia usually leads to liver failure. But in some cases, the Kasai procedure can slow or prevent it.

How should I prepare my baby for the Kasai procedure?

Your baby’s provider will prepare them for surgery by giving your baby intravenous (IV) fluids to keep them hydrated, maintain their sugar levels and provide nutrients. They’ll also give your baby antibiotics intravenously to reduce the risk of infection. During surgery, your baby might also need blood products, like red blood cells or platelets.

Before starting the Kasai procedure, your baby’s surgeon needs to make sure they have biliary atresia. To do that, they perform a cholangiogram, a procedure that allows the surgeon to inspect your baby’s bile ducts.

To start the cholangiogram, the surgeon makes an incision below your baby’s ribs on the right side of their belly. Or, using laparoscopic surgery, they place a small tube into your baby’s gallbladder. Then, the surgeon injects medication that helps find the bile ducts using an X-ray machine. If your baby has a blocked gallbladder and bile ducts that prevent bile from draining from their liver, your baby has biliary atresia.

What happens during a Kasai procedure?

During the Kasai procedure, the surgeon removes your baby’s gallbladder and abnormal bile ducts, where they connect with the liver. They then use a piece of your baby’s small intestine — called the jejunum — to replace the damaged bile ducts, making a connection between their liver and their intestine.

If successful, this connection allows bile to drain into your baby’s intestine, stopping the effects of biliary atresia.

The surgery may take several hours.

What happens after a Kasai procedure?

Following the Kasai procedure, your baby will spend five to 10 days in intensive care to recover. They won’t eat for the first few days after the procedure, giving their internal wounds a better chance to heal. Your baby’s providers will deliver nutrients intravenously these first days. After, they’ll feed through a nasogastric tube (a feeding tube inserted through their nose). Gradually, your baby will begin to take food through their mouth. Their surgeon will also put surgical drains around your baby’s incision to help remove fluids from the wound and promote healing. They’ll take the drains out before your baby leaves the hospital.

While in the hospital, providers watch your baby closely for signs of bleeding, bile leakage, gas and pooping. These indicate that bile is draining correctly from their liver into their intestines. Your baby may need some medications to help improve the drainage. Once your baby’s intestine starts functioning again, they can start feeding. The surgeon will let your baby go home once their incision begins to heal, their liver functions improve, and they can tolerate formula or breastfeeding (chestfeeding).

What are the benefits of the Kasai procedure?

The benefits of the Kasai procedure include:

• Restoring bile flow.
• Making sure your baby gets the proper nutrients.
• Curing jaundice.
• Promoting your baby’s growth.

How successful is the Kasai procedure?

The success rate of the Kasai procedure is highest when your baby is between 6 weeks and 2 months old, has minimal liver damage and has a skilled and experienced surgeon. Under these conditions, the Kasai procedure can reduce biliary atresia symptoms — especially jaundice — in more than 60% of infants.

Signs of a successful surgery include the return of normal color to your baby’s poop and improved liver functioning test results. Your baby’s healthcare team considers the Kasai procedure a success if your baby doesn’t have jaundice for six months after surgery.

What are the risks or complications of the Kasai procedure?

A common complication after the Kasai procedure is a liver infection called cholangitis. Your baby’s provider may prescribe antibiotics after surgery to help prevent this. If an infection occurs, your baby’s doctor will treat it with intravenous antibiotics.

What if the Kasai procedure doesn’t work?

If the Kasai procedure doesn’t work and your baby’s bile ducts are still blocked, they’ll likely need a liver transplant. It’s not uncommon. In fact, about half of babies who have the surgery will need a liver transplant by age 2.

How long will it take for my baby to recover?

It will take about three to four months for your baby to recover from the Kasai procedure. Here are some steps you can take to speed up their recovery and avoid problems once they get home:

• Give your baby the medications as their surgeon prescribed. They’ll have to take oral antibiotics for several months and bile replacement medications for several years. The antibiotics will help your baby avoid common infections, and the bile replacement medication will improve your baby’s bile flow. Keep track of their medicines and test results.
• Ask your baby’s provider how to care for your baby’s incision and what type of bandages to use.
• Go to all your baby’s doctor appointments after the surgery. It’s very important to stay on top of your baby’s recovery.
• Tell your doctor right away if you notice anything different with your baby.
• Wash your hands often to prevent the spread of infection.
• Avoid getting a cold or the flu to protect your baby from additional health risks.
• Make sure everyone in your family has had all their vaccines to reduce the risk of transmitting infections to your baby.
• Breastfeed your baby if possible. Most providers prefer breastfeeding because it provides the fats the liver can absorb easily. If you can’t breastfeed, your baby’s surgeon can recommend a special formula.

When should I call my healthcare provider?

Contact your provider immediately if you notice any signs of infection or liver disease in the days and weeks following the Kasai procedure, including:

• Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or more.
• If your baby refuses to eat.
• Swelling or oozing from the incision.
• If your baby cries when you touch their belly, which means it hurts.
• Swollen stomach.
• Unusual bruising or bleeding.
• No pooping for more than three days.
• Watery diarrhea for more than three days.
• Jaundice that returns or gets worse.
• Pale or white poop.
• Bloody poop or vomit.