Pediatric Kasai Procedure and Outcomes for Biliary Atresia

The Kasai procedure is named after Dr. Morio Kasai, the Japanese surgeon who developed it in 1951. You might also hear your health care provider refer to it as a "Roux-en-Y" or a "hepatoportojejunostomy" (pronounced "he-pat-o-port-o-jeh-joo-nah-sto-me").

What Is the Kasai Procedure?

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.

What Happens During the Kasai Procedure?

To perform the Kasai procedure, surgeons first carefully remove the damaged ducts outside of the liver. They use a small segment of the patient's own intestine to replace the ducts at the spot where bile is expected to drain. This segment not only connects to the liver, but also connects to the rest of the intestine. The Y-shaped passageway formed by the Kasai operation allows bile to flow from the liver into the intestine.

After the Kasai Procedure

If your child needs a Kasai procedure, he or she 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, or excessive fluid build-up.

Outcomes of the Kasai Procedure

In the long-term, antibiotic therapy helps reduce the risk of infection entering the liver through the intestine. 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.

When the Kasai procedure is done at an early age (younger than three months), about 80 percent of patients have some bile flow. In nearly 30 percent of those infants, enough bile is able to drain from the liver that bilirubin levels return to normal. In the smaller number of patients who don't benefit from the operation, some of the obstructed bile ducts are inside the liver as well as outside. When this happens, liver transplantation is needed sooner to correct the problem.

Learn more about other Liver Transplant Procedures.