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What is Kasai Procedure | Biliary Atresia Awareness and Research

What is Kasai Procedure

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Treatments of BA
May 6, 2014
Live on the Radio for BC Childrens Hospital
May 7, 2014
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The Kasai procedure is named after Dr. Morio Kasai, the Japanese surgeon who developed it in 1951. It was first introduced to the UK in the 1960s, and to Canada and America in the early 1970’s.

It is often referred to as a “Roux-en-Y” or a “hepatoportoenterostomy”.


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. Without this surgery, a child with Biliary Atresia is unlikely to live beyond the age of 2, unless a liver transplant is performed.

What happens?


In the Kasai procedure the damaged duct outside the liver is removed and replaced with a new drainage system made from a piece of the small intestine to form a Y-shaped passageway which connects to both the liver and the rest of the intestine. This allows bile to drain, correcting many of the problems of Biliary Atresia.

The operation takes approximately 6 hours and the baby 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 (excessive fluid build-up).

The earlier Biliary Atresia is detected, the less damage it will have done to the liver and the better the chance of a successful Kasai. The current target is to treat babies before they are eight weeks old. The Kasai procedure is successful in over 60% of cases restoring bile flow and allowing bilirubin levels to return to normal.


The current target is to treat babies before they are eight weeks old.


Unfortunately, in the majority of cases the Kasai procedure is not successful and bile flow is not restored. In these cases the child will likely develop worsening liver disease and cirrhosis requiring liver transplantation within the first 1 to 3 years of life.

Even when initially successful, and the operation partially or fully alleviates the jaundice, it is not usually a cure of Biliary Atresia. It will not reverse the liver damage that has already occurred nor totally restore normal liver development and function. The child may experience ongoing cirrhosis and related complications that require a liver transplant later in childhood. Very few reach their teens or adulthood with their own livers.

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.

The operation is extremely intricate and is best carried out in a centre with expertise in this area. For this reason, in the UK, it is now recommended that affected children are treated at one of three UK specialist centres (Kings College Hospital, London, Birmingham Children’s Hospital and St James’ Hospital, Leeds). Due to the vast land area of both Canada and America it has not yet been practical to create such centres of expertise, although the benefit is recognised. Therefore other avenues are being explored.