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A medical disease that affects infants' bile ducts is called biliary atresia. These ducts, which transport digestive secretions from the liver to the intestines, may be excessively small, obstructed, or undetectable. As a result, the liver endures significant damage from bile accumulation.
"A Kasai operation, also known as a "Hepatoportoenterostomy," is a surgical procedure in which the child's intestine is used to replace the damaged bile ducts at the base of the liver to restore bile flow from the liver."
The Kasai procedure (hepatoportoenterostomy) is performed to treat biliary atresia, a rare liver condition in infants where bile ducts are blocked or absent. The surgery helps restore bile flow from the liver to the intestine, preventing liver damage, jaundice, and eventual liver failure.
Parents should seek medical attention if their newborn has persistent jaundice beyond 2 weeks, pale or clay-colored stools, dark urine, enlarged liver, or poor weight gain. Early detection is critical, as the procedure is most effective when performed before 8 weeks of age.
Preparation includes blood tests, liver function tests, abdominal ultrasound, liver biopsy, and sometimes cholangiography (imaging of bile ducts). Parents are advised on the procedure, risks, and potential need for future liver transplant. The infant may need to fast before surgery.
The Kasai procedure involves:
- Removing the damaged or missing bile ducts outside the liver.
- Attaching a loop of the small intestine directly to the liver at the porta hepatis (the area where bile normally drains).
- This allows bile to drain directly from the liver into the intestine.
The surgery typically takes 4–6 hours. Depending on recovery and complications, the hospital stay is usually 1–2 weeks.
- Cholangitis (bile duct infection)
- Liver scarring (cirrhosis)
- Bleeding
- Portal hypertension
- Malnutrition
- Can restore bile flow and relieve jaundice
- May delay or avoid the need for liver transplantation
- Improves growth and nutrition in affected infants
Recovery involves antibiotics to prevent infection, nutritional support, and regular follow-ups to monitor liver function. Some children may need fat-soluble vitamin supplements. Long-term monitoring is necessary for signs of liver damage.
Success depends on the age at surgery and the degree of liver damage. If performed early (ideally before 8 weeks), bile flow is restored in about 30–60% of cases. However, over 50% of patients eventually require liver transplantation, usually by early childhood.
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Taoufik Clinique
Tunis, Tunisia
Taoufik Clinique located in Tunis, Tunisia is accredited by JCI. Also listed below are some of the most prominent infrastructural details:
- Laboratory services and High end medical imaging equipment is present at this clinic.
- Emergency care services are also available.
- The clinic has a health checkup center as well as an operation theatre.
- The important disciplines at this hospital are cardiology, orthopedics, cosmetic surgery, oncology, urology, bariatric surgery, and gastroenterology among others.
- Some cardiac conditions treated here are peripheral vascular disorder, heart valves disorder, cardiac muscle diseases, and acute and chronic pericarditis.
- Orthopedic and spine surgery which also includes treatment of sports related injuries, and disorders of both upper and lower limb.
- Cancer treatment is performed in Taoufik Clinique through chemotherapy, surgery, and radiation therapy.
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+99Process Involved for Kasai Procedure in Tunis
- Pre-Operative Evaluation: Blood tests, liver function tests, and an abdominal ultrasound for confirmation of biliary atresia with liver biopsy.
- Surgical Procedure: Anastomosis of a segment of the small bowel to the liver to restore bile flow and replace the obstructed extrahepatic bile ducts.
- Post-Operative Recovery: The patient stays in the hospital for observation, assessment of bile flow, administration of medications to prevent infection, and long-term evaluation of liver function.
- Traditional Kasai Procedure (Hepatoportoenterostomy): The blocked bile duct is removed and creates a connection between the liver and small intestine.
- Modified Kasai: Additional bile duct remnants are removed or altered to enable better bile drainage.
- Biliary atresia should be diagnosed in infants before two to three months of age.
- Symptoms are persistent jaundice in most cases, with possible pale stools, dark urine, and hepatomegaly.
- There should not be other major congenital malformations that may add surgical risks.
- Abdominal Ultrasound
- HIDA Scan (Cholescintigraphy)
- Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Liver Function Tests (LFTs)
- If successful, it would provide some delay or sometimes even negate the need for a liver transplant.
- Improving bile drainage decreases jaundice and aids digestion.
- If bile flow is restored, normal growth and development may proceed.
- In some cases, it may prolong a child's life for several years before a transplant is warranted.
- Pediatric Surgeon
- Pediatric Gastroenterologist
- Pediatric Hepatologist
- Neonatologist
- Nutritionist
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