Kasai Procedure - Surgery, Operation, Scar, Recovery & Care

The purpose of the surgery is to create a passage to allow the bile to drain directly from the liver into the small intestine, bypassing the gallbladder and the various ducts. The doctor will:

1. Make a cut below the ribs on the right of the abdomen to inspect the bile ducts.
2. Perform a cholangiogram to confirm the diagnosis of biliary atresia. The doctor puts a small tube into the gallbladder and injects medication to find the bile ducts using an X-ray. If the bile ducts and gallbladder are not open and the bile cannot be drained, then the baby will have biliary atresia.
3. Remove the damaged bile ducts and abnormal gallbladder outside of the liver.
4. Replaces them with the patient’s small intestine.
5. The new small intestine bypass drains the liver directly to the duodenum.

Before the Kasai Procedure

1. Perform blood tests to check the baby’s blood group (if the baby requires blood before, during and after the surgery) and other tests like ultrasound, liver biopsy, cholangiogram (a dye injected into the gallbladder to see the main bile duct), and hepatobiliary scan.
2. Explain to the parent what the surgery involves.
3. Give special medicines to the baby to prepare the gut for the Kasai surgery.
4. Inform the parent not to feed milk a few hours before the surgery.
5. Ask the mother to speak to the nurse if you are breastfeeding for milk storage.

On the day of the Kasai Procedure

On the day of surgery, the patient must expect the following:

1. The surgery may last a whole morning or afternoon.
2. The doctor will administer fluids and pain-relieving medicines through the IV.
3. The anesthesiologist will inject general anaesthesia to make the baby unconscious.
4. The baby will be continuously monitored throughout and after the surgery.

During the Kasai Procedure

During the surgery, the doctor will:

1. Assess the liver to check for any abnormalities.
2. Remove a tiny piece of the liver for liver biopsy.
3. Carry out the Kasai operation and make a new tube for bile passage, by using a small loop of the intestine as a replacement.
4. One end will be connected to the liver, and the other end of the tube will drain the bile from the liver directly into the small intestine part called the duodenum.
5. Remove the gallbladder and all the abnormal bile ducts outside the liver.

In Hospital

After the surgery, the doctor will:

1. Cover the wound with dressing for the first few days. 
2. Insert a urinary catheter to drain urine from the bladder. This measures the urine output to ensure that the kidneys are working properly.
3. Place an abdominal drain to drain the excess fluid and blood from the liver.
4. The baby will be moved to the recovery area.
5. Notify the parents about the nasogastric tube that runs from the baby’s nose into the stomach. The parent will not be allowed to feed the baby for a few days.
6. Inform the parents to keep the baby’s stomach empty for 48 to 72 hours.
7. Give pain-relieving medicines through the small tube inserted into the baby’s nose during the surgery.
8. Give antibiotics through an intravenous (IV) for three to five days. Fluid and blood products are given through the IV too. The fluids balance the salt, sugar, and water level in the body.
9. Allow taking the baby home after seven to ten days, depending on the baby’s recovery. 

At Home 

The parents should:

1. Ask the parents to weigh the baby every week to monitor weight gain. 
2. Tell the parents to check the baby's temperature, stool, urine, and general health for signs of infection and jaundice. 
3. Clean the surgical area as instructed by the doctor. 
4. Give medications, like antibiotics, vitamins, steroids, Ursodeoxycholic acid (URSO), ranitidine, etc., as per the baby’s condition.
5. If the baby develops a fever, stops eating, has fewer wet diapers, or feels weak, parents should consult their doctor. 

First follow-up appointment

The doctor will discuss the follow-up plan with the parents. The first follow-up appointment is mostly scheduled two weeks after the discharge from the hospital to monitor liver function and its growth.

The baby should also follow up with their pediatric gastroenterologist and pediatric surgeon. After the surgery, the patient must visit their doctor for the first five years to monitor the liver.

The benefits of the Kasai surgery are that the procedure:

1. Helps lower the symptoms of biliary atresia.
2. Prevents liver damage and cirrhosis.
3. Reduces the chances of needing a liver transplant.

The risks and complications that can occur during the Kasai procedure include:

1. Bleeding
2. Infection
3. Hole in the intestine
4. Acute kidney injury

When is consultation with the Doctor needed?

Parents should consult the doctor if they notice any side effects and complications. Possible risks/complications that may occur after the surgery include:

1. Bleeding from the surgical site
2. Kasai procedure scar causing intestinal blockage
3. Infection of the liver and bile ducts (cholangitis)
4. Hole in the intestine, causing leakage of the intestinal contents into the stomach.
5. Itching of the skin
6. Portal hypertension (high blood pressure in the portal vein that carries blood from the stomach to the liver).

The cost of Kasai Procedure ranges from ₹2,00,000 to ₹4,00,000. The cost varies based on the following factors:

1. Type of Kasai surgery
2. Age of the patient
3. The medical condition of the patient
4. The type of hospital facility availed - individual room or shared.