Kasai operation

Kasai operation, also known as Kasai portoenterostomy, is a surgical procedure used to treat biliary atresia, a serious condition in infants where the bile ducts inside or outside the liver are scarred and blocked. Bile ducts are crucial for the transportation of bile from the liver to the gallbladder and then to the small intestine, where it aids in the digestion of fats. The Kasai operation is named after the Japanese surgeon Morio Kasai, who developed the procedure in the 1950s.

Indications

The primary indication for the Kasai operation is biliary atresia, diagnosed in newborns. Biliary atresia leads to bile flow obstruction, which can cause significant liver damage and cirrhosis. If left untreated, it often results in liver failure within the first two years of life. The Kasai operation is most effective if performed before the infant is 8 to 10 weeks old.

Procedure

The Kasai operation involves removing the damaged bile ducts outside the liver and creating a direct connection between the liver and the small intestine. This is achieved by attaching a loop of the small intestine directly to the liver at the spot where bile is expected to drain. The goal is to restore bile flow from the liver into the intestine, thereby preventing the buildup of bile and reducing the risk of liver damage.

Outcomes

The success of the Kasai operation varies. In some cases, bile flow is successfully restored, and the child can grow and develop relatively normally, although long-term monitoring and medications may be necessary. However, in many cases, the operation does not fully restore bile flow, and the child may eventually require a liver transplant. The earlier the surgery is performed, the better the outcome tends to be.

Complications

Complications from the Kasai operation can include infection, bleeding, formation of scar tissue, and continued liver damage leading to liver failure. Long-term complications may also include portal hypertension and the development of varices, which are enlarged veins in the esophagus or stomach that can bleed.

Aftercare

After the Kasai operation, close monitoring in a hospital is necessary to watch for signs of bile flow restoration, infection, or complications. Long-term care involves regular follow-ups with a pediatric liver specialist, blood tests to monitor liver function, and medications to help with bile flow and reduce the risk of liver damage.