South Korea is associated with being a technologically advanced country where technology has been playing a strong role in making the lives of the people easier in various fields for several years. Even so in healthcare, one of the foremost advantages is technological intervention. The other plus points of the healthcare ecosystem in South Korea are the exceptionally qualified and trained surgeons, even so pediatric surgeons and the sharp yet modern hospital and clinic infrastructure.
A major operation done in infants below three months of age, Kasai procedure is performed to ensure that the need for a liver transplant is avoided or delayed. Biliary atresia, or extrahepatic ductopenia and progressive obliterative cholangiopathy is a condition of the liver in infants. In this procedure, the effort is to work around the bile ducts being blocked, absent or being really narrow.
The chances of ultimately having to get a liver transplant by the time the patient turns 20 are as high as 80%.This procedure makes sure that at least 30% of the infants will not have to get a transplant and the rest end up having time on their side.
The cost of Kasai procedure in South Korea is US$ 40,000 to US$ 50,000 which is much lower than the cost of the Kasai procedure in the United States of America which is US$ 80,000 to US$ 1,00,000.
Hepatoportoenterostomy or Kasai Portoenterostomy (the Kasai procedure) is a surgical procedure for the treatment of Biliary atresia. This is a gastrointestinal condition wherein the biliary system can be either missing or closed because the bile ducts bringing back bile flow from liver to intestine are damaged or destroyed.
Discuss with the surgeon the best process to operate and ensure that they follow through with it. There are restrictions related to food and drink and kids, details are mentioned here,
Solid Food: 6 hours before surgery
Formula Milk: 6 hours before surgery
Breast Milk: 4 hours before surgery
Clear Fluids: 1 hour before surgery
Please remain in contact with the surgeon regarding the medications that the child is taking as this can have a bearing on the timeline of the surgery.
Some preparations are done prior to the surgery such as an Electrocardiogram (ECG), Pulse Oximetry, and Intravenous line inserted into the vein of the foot or non-dominant hand. A nasogastric tube may be inserted into the nostril so that food reaches the stomach post-surgery. The anesthesiologist will also prepare you before the surgery as to what is in store and likely ask you questions about the child’s health parameters.
This procedure takes about 4 hours to complete and is performed by Pediatric surgeons who have had specialized training in providing treatment through operations in children. Many small incisions (laparoscopic) and not one large incision (open surgery) can be employed by the surgeon in performing this surgery.
Bile ducts and gallbladder are replaced with part of the child's small intestine which is attached to the liver and starts working as an extrahepatic bile duct system. This ensures that the Liver to intestine bile flow is maintained as the two are now directly joined with each other.
There are, understandably a lot of risks and complications that can be associated with the Kasai Procedure (major surgery) and these are as follows:
The benefit of the Kasai Procedure is that in 1/3 rd kids, bile flow restoration goes to normal and liver function improves substantially. The rest may still end up requiring liver transplantation, 50 percent soon enough, rest a bit later.
The time taken for the bile flow to return to normal may be several months. You should ensure to have a post-procedure follow-up appointment with the Gastroenterologist, Hepatologist, and surgeon so as to monitor changes in the bile output, liver status after two to three weeks from the procedure. During this time blood tests are done which are an indication of improving liver function, Alkaline phosphatase, gamma-glutamyltransferase, and bilirubin test. Also, ultrasound elastography or FibroScan is performed to evaluate liver fibrosis, its presence, and extent.
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