Kasai Procedure To Treat Bilary Artesia In Infants

Biliary Artesia is a serious condition affecting infants. It is a congenital defect in which the common bile duct between the liver and the small intestine carrying bile is blocked, malformed or missing. It occurs in about 1 in 10,000 to 1 in 15,000 live births in the United States. Infants with this condition will progressively show signs of cholestasis where the bile flow is obstructed, accumulates and sets off a necrotizing action in the cells of the bile ducts and the liver.
The condition is generally treated with a surgical procedure, namely, the

kasai procedure.

Kasai Procedure

Condition In Biliary Artesia

The Kasai Procedure

This procedure is also known as the Hepaportoenterostomy or Kasai portoenterostomy. It is a surgery conducted to repair the blocked common bile duct in infants suffering from biliary artesia. In these infants, because of the blockage the bile fails to drain from the intra- hepatic bile ducts (bile ducts within the liver) to the extra-hepatic bile ducts(bile ducts outside the liver) that connect the gall bladder to the small intestine.

It exposes the porta hepatis, the area in the liver where the bile is accumulated and should drain. The surgery reconstructs a functional bile duct with a loop from the intestine and attaches it to the intra-hepatic bile ducts in the porta hepatis. The liver now directly drains the bile in the intestine.

Extra-hepatic Biliary Artesia

The procedure works only when there is a problem with the extra-hepatic bile ducts. If the intra-hepatic bile duct is missing or blocked the procedure is ineffective.

The procedure if performed before the child is of two months age , the success rate is pretty good. The earlier the surgery is done, better is the success rate.

Complications from the kasai procedure

Infection in the bile duct

: A common complication of the surgery is the development of an infection in the biliary tubes. The bacteria from the gut flows back into the biliary tree and causes the infection. It is important to arrest the infection immediately with intravenous and oral antibiotics. Otherwise there is a risk of the development of ascending cholangitis (inflammation and infection of the bile duct). Jaundice, pale stools and fever are some of the symptoms of the condition.

Skin Condition

: The yellowing of skin, as in jaundice, can worsen. It is treated with phototherapy where the child is exposed to different frequencies of light. Or it is treated with an induced enzyme therapy, commonly known as phenobarbital therapy. Pruritas or the increased itching on skin can happen because of a bile leak after the surgery.


: Despite surgery, the infant may not show signs of improvement and may progressively advance towards a condition where the liver cells are scarred and damaged, namely, cirrhosis of liver. In that condition, only liver transplantation can save the patient.

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