An operation called the Kasai procedure is done to connect the liver to the small intestine, going around the abnormal ducts. Age a … Assessment of choledochal cysts (11,57–64) The Kasai procedure is usually the first treatment for biliary atresia. There are no contraindications for treatment. Clinical data were compared between open and laparoscopic revisions of Kasai. During the procedure, a surgeon removes the damaged bile ducts outside the liver. If the procedure is not successful, the flow of bile will remain blocked. When the procedure is performed after the infant is 120 days old, hepatoportoenterostomy is largely ineffective, with drainage in only 10% to 20% of patients. The Kasai procedure, or Kasai portoenterostomy, replaces the infant’s damaged bile ducts with a section of the infant’s intestine. Your child will need an appointment with the Gastroenterologist and our surgeon two or three weeks after discharge from the hospital. www.uptodate.com/contents/biliary-atresia. Preoperative histology and ductal remnant size After the procedure, a common complication is infection of the liver, called cholangitis. 1996 May. The earlier the procedure is … However, a liver transplant may still be needed. Open revision of Kasai was performed in 20 patients after open Kasai, and Lap-revision was performed in 4 patients after Lap-Kasai. It involves a problem with the bile ducts. Portosystemic shunt for portal hypertension after Kasai operation in patients with biliary atresia. 6:5-52. . In some cases, after a successful procedure, children never need a liver transplant. The earlier the procedure is done, the more effective it may be. The remaining two thirds of children who undergo the Kasai procedure will not have adequate bile flow and liver function, and will eventually require liver transplantation. Liver Transplantation. Within 3 months of the procedure, one has an idea of whether the surgery has worked or not. The operation connects the bile draining from the liver directly to the gastrointestinal (GI) tract. The Kasai procedure is named after Dr. Morio Kasai, the Japanese surgeon who developed it in 1951. Please call our office if you have any questions or concerns after the surgery. This segment of intestine is sewn to the liver and functions as a new extrahepatic bile duct system. It is most successful when done early in the disease process. The Kasai procedure tends to be more successful the earlier it's done. The Kasai procedure does not cure biliary atresia. If biliary atresia leads to serious complications, the infant or child will need a liver transplant. The surgeon uses a loop of the infant’s own small intestine to replace the damaged bile ducts. Although revision of Kasai could achieve adequate biliary drainage, surgeons may avoid repeated abdominal procedures to treat BA because they may have a negative effect on the outcomes of subsequent LT [ 5 , 6 ]. The procedure is feasible and safe. The success rate is high. Long-term results with the Kasai operation for biliary atresia. Biliary atresia: 50 years after the first Kasai. 75 Progressive destruction of intrahepatic ducts and ascending cholangitis occur in roughly 50% of patients after the Kasai procedure and lead to progressive biliary cirrhosis. This segment of intestine is sewn to the liver and functions as a new extrahepatic bile duct system. 3–8 Several studies have proposed that early diagnosis and treatment is key to the restoration of bile flow and favorable prognosis. The Kasai procedure involves removing the blocked bile ducts and gallbladder and replacing them with a segment of your child's own small intestine. Get the latest public health information from CDC: www.coronavirus.gov Biliary atresia is the most common indication for liver transplantation in the pediatric age group. We reviewed the significance, optimal timing, operative procedures, and indications of Kasai redo surgery. Results. The Kasai procedure is performed upon the diagnosis of biliary atresia. The Kasai procedure does not cure biliary atresia. We reviewed the significance, optimal timing, operative procedures, and indications of Kasai redo surgery. Although results with Kasai’s procedure are good, eventually a liver transplant is required in up to 80% patients. However, if the procedure is successful, it may slow liver damage and delay or prevent complications and the need for a liver transplant. Despite advances in biliary atresia surgical techniques, most children will ultimately require liver transplantation. Kasai M. Treatment of biliary atresia with special reference to hepatic porto- enterostomy and its modifications. Open revision of Kasai was performed in 20 patients after open Kasai, and Lap-revision was performed in 4 patients after Lap-Kasai. Thanks to advances in treatment, more than 80 to 90 percent of infants with biliary atresia survive to adulthood.5,6. The same cannot be done in the patients who had poor bile flow after the index procedure. After an unsuccessful procedure, infants will develop complications of biliary atresia and will usually need a liver transplant by age 2.5. • All patients including preterm infants should undergo surgery as soon as possible. • The outcome is poor after a redo Kasai procedure for bile excretion failure. The Kasai procedure is usually the first treatment for biliary atresia. Prog Pediatr Surg. The Kasai portoenterostomy procedure has been the first-line treatment of BA since 1959, although the pathogenesis is largely unknown. The Kasai procedure is the preferred treatment for biliary atresia at The Children's Hospital of Philadelphia and has been performed here for more than 30 years. Kasai is unsuccessful in some patients, but the necessity and indications for revision of Kasai are controversial [2–6]. In these infants, the bile is not able to drain normally from the small bile ducts within the liver into the larger bile ducts that connect to the gall bladder and small intestine. The Kasai procedure involves removing the blocked bile ducts and gallbladder and replacing them with a segment of your child's own small intestine. Of this group, half will need transplantation soon after the Kasai procedure and half will need transplantation at a later time. One or two weeks after you arrive home from the operation a nurse from our office will call you to see how your child is doing. Once your child is able to eat well, has no fever, and is comfortable on pain medication by mouth, he or she will be discharged home. If the Kasai procedure is not successful, the only other option is a liver transplant. proaches to the speciﬁc indications and complications that have developed. Biliary Atresia (BA) is the commonest neonatal liver disease in New Zealand affecting 1 in 8000 live births, with increased frequency in Maori and Pacific children (approximately 1 in 5000). The surgeon will determine the safest method of operating and will discuss this with you before the procedure takes place. The standard treatment for biliary atresia is the Kasai procedure. A hepatoportoenterostomy or Kasai portoenterostomy is a surgical treatment performed on infants with Type IVb choledochal cyst and biliary atresia to allow for bile drainage. Therefore, the Kasai procedure may be a good choice for the management of complex hilar biliary strictures that cannot be addressed by standard surgical methods. COVID-19 is an emerging, rapidly evolving situation. Center for Hernia Repair & Abdominal Wall Reconstruction, Center for Limb Preservation and Diabetic Foot, T32 Research Training in Transplant Surgery, Cardiothoracic Translational Research Lab, Center for Global Surgery and Health Equity, Center for Maternal-Fetal Precision Medicine, Chang Laboratory for Liver Tissue Engineering. Factors that predict improved long-term outcome after Kasai portoenterostomy include the following: Younger than 8 weeks at operation.