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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.

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Before the Treatment

How it is Performed

Preparing for the Procedure

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.

During the Procedure

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.


Possible Risks and Complications of Kasai Procedure

There are, understandably a lot of risks and complications that can be associated with the Kasai Procedure (major surgery) and these are as follows:

  • Pain
  • Postoperative Infection
  • Adverse reaction to Anesthesia
  • Acute Cholangitis
  • Portal Hypertension
  • Hepatopulmonary Syndrome

Benefits of Kasai Procedure

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.

Follow-Up Care Post-Kasai Procedure

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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Kasai Procedure