Kasai Procedure
If your child is diagnosed with biliary atresia, their next treatment step is a Kasai portoenterostomy (KPE) operation (also called hepatoportoenterostomy). For many parents, this can feel dizzying. You’re just adjusting to a serious medical condition. Then you’re asked about a major surgery. You want to know your child is safe.
At UVA Health Children’s, our liver specialists (hepatologists) and surgeons are equipped to help you through this.
Getting Your Child’s Kasai at UVA Health Children’s
Following a diagnosis of biliary atresia, we’ll work to schedule your child’s KPE as quickly as possible. That’s because KPE surgeries performed in the first two months of a child’s life offer the best outcomes. Some of these children will never need a liver transplant.
Confirming Biliary Atresia
Before performing the KPE, we’ll confirm your child’s diagnosis. To do this, we need to perform cholangiography. This is an imaging technique that usually involves surgery, so we wait until all the other diagnostic tests we can perform show that it’s necessary.
During this operation, we’ll use medicine to keep your child asleep. This will also keep them from feeling pain.
We’ll use a minimally-invasive laparoscopic technique. We’ll make a small incision in your child’s side. Then, we’ll use a special liquid that shows up on x-ray to see the bile ducts, gallbladder, and intestine. That shows us where bile is getting stuck. If the bile can’t drain, then we know it’s biliary atresia.
Sometimes cholangiography can be performed at the same time as a liver biopsy, before your child might need an operation. We have some of the best interventional radiologists in the world to perform this technique when it is appropriate.
Kasai Portoenterostomy Procedure (KPE)
The KPE operation involves removing the parts of the bile system that are damaged and not open. Usually, that’s the gallbladder and all of the bile ducts outside of the liver.
The surgeon directly connects the liver to the small intestine.
During recovery, we’ll keep your child in the hospital for 7-10 days for monitoring. During this time, we’ll also give them antibiotics and monitor them for infection. We want them to be able to eat comfortably before leaving the hospital.
For many children, the KPE restores bile flow. That means that their body will be able to digest food and grow normally and this prevents ongoing damage to the liver. They’ll still need follow-up care.
Unfortunately, for some children, the procedure only restores some bile flow and the liver damage is slowed but continues. That means they’ll eventually need a liver transplant. But the procedure still buys us valuable time. We’ll help you with your child’s liver transplant.
Living Liver Donation
Thanks to living organ transplantation, more children than ever are making the match of a lifetime. Because the liver can grow back, both donor and recipient end up with a healthy liver. Parents are often a good match for their children. If you're not, our transplantation program can help you understand your options.
Life After Surgery
While your child’s new biliary system is incredible, it’s not quite the same, and the child sometimes doesn’t absorb some vitamins as well. The doctors will make sure that your child gets the right vitamin supplements as needed.
You’ll also need to schedule regular follow-up visits. During these visits, your child’s liver function can be checked. Unfortunately, sometimes liver damage and scarring continues. If that happens, your child may need a liver transplant.
By the age of 2 years, roughly 50% of biliary atresia patients will need a liver transplant. We will know more about the likelihood of this happening in the first few months after the KPE.
KPE Frequently Asked Questions
Your child’s doctor and surgeon will answer all of the questions you have through this process. But here are some of the questions a lot of patients have.
Why not just get a liver transplant?
No parent wants their child to go through unnecessary surgery. Finding out that after the KPE their child will likely still need a liver transplant is very frustrating. And many parents want to know why bother with the KPE at all?
The answer is that the KPE is easier to recover from than a liver transplant. It gives us time to find a transplant donor. Children who are older and stronger also have an easier time recovering from a liver transplant.
Also, with better techniques and follow-up, we’ve seen an increase in children who don’t need a liver transplant at all.
Will my child be normal afterwards?
Many children overcome medical obstacles at a young age. While they may need medication or a few more doctor visits a year, they’re otherwise free to be kids. We’ll make sure you know what to do in an emergency. But otherwise we encourage you to treat your child the same.
Why is it called a Kasai?
It’s named after the doctor who first performed it, Morio Kasai. Its technical name is a hepatoportoenterostomy. Everyone calls it a Kasai.
Will my child have a long life after?
The truth is that techniques for treating biliary atresia have come such a long way in such a short time, it’s impossible to predict what’s next. But in recent history many children born with biliary atresia are living long, healthy lives with regular liver follow-up.