The Kasai procedure refers to removing the blocked bile ducts and gallbladder and replacing them with a segment of your child's own small intestine. This segment of intestine is sewn to the liver and functions as a new extrahepatic bile duct system. The surgeon may be able to operate through many small incisions (laparoscopic surgery) instead of one large (open surgery) incision. Generally, operation will take approximately 4 hours to complete.
Causes
The flow of bile, a fluid produced by the liver that aids with digestion, can become obstructed when the ducts do not form properly during pregnancy. If left untreated, the condition, called biliary atresia, can cause severe liver damage due to the backflow of bile. The Kasai procedure is considered the first-line treatment of biliary atresia.
Doctors will often suspect biliary atresia when the following cascade of symptoms develops within two and six weeks of birth:
Persistent jaundice (yellowing of the skin and eyes)
Pale, chalky stools
Dark urine
Hepatomegaly (enlarged liver)
Splenomegaly (enlarged spleen)
Poor weight gain
Risk Involved in Kasai Procedure
Acute cholangitis: Serious infection of the biliary tract, manifesting with fever, abdominal pain, nausea, vomiting, and jaundice, can usually be treated effectively with intravenous antibiotics.
Portal hypertension: This postoperative complication, characterized by abnormally high blood pressure in the liver, generally affects children who already have significant liver scarring. It can lead to bloody stools, bloody vomit, and the abnormal swelling of the abdomen. Portal hypertension is usually an indication of a poor prognosis.
Hepatopulmonary syndrome: This surgical complication, characterized by shortness of breath, cyanosis (bluing of the skin), and finger clubbing, is caused by dilation of blood vessels in the lungs and usually affects those who have already sustained significant liver damage. Liver transplantation is likely the only viable option at this stage.
Before the surgery
Nurse will take your child's weight and height (which helps calculate the correct anesthesia dose) and vital signs (including temperature, heart rate, and blood pressure).Then the child is prepared for surgery either in a private or semi-private room or cubicle. Because the preoperative procedures can be scary and uncomfortable for children, the nurse may provide a mild sedative to induce relaxation and prevent squirming or panic.
Preoperative preparations will involve the following.
Electrocardiogram (ECG): Used to monitor heart activity, the ECG is connected to the child's torso via adhesive electrodes.
Pulse oximetry: Used to monitor blood oxygen saturation, the pulse oximeter is typically attached to the child's big toe with a velcro strap.
Intravenous line: Used to deliver anesthesia, medications, and fluids, the intravenous (IV) line is usually inserted into a vein in the foot of non-walking children. It can also be inserted into the non-dominant hand.
During Surgery
Once the child prepped for surgery and wheeled into the surgical suite, anesthesia will be given. Depending on whether the surgery is open or laparoscopic, the choices include the following.
General anesthesia: This is a type of anesthesia delivered by IV that puts the child into an unconscious state. It is used for open surgery but may also be chosen for laparoscopic surgery in children with advanced liver disease.
Regional anesthesia: This form of anesthesia is used to block pain signals. It may involve a peripheral nerve block (involving an injection near a bundle of nerves) or an epidural (involving an injection into the spine). Regional anesthesia is commonly supported by monitored anesthesia care, a form of IV sedation used to induce a "twilight sleep”. There are two major stages tothe Kasai procedure: biliary duct resection and Roux-en-Y hepaticojejunostomy.
Biliary Duct Resection
The surgeon starts by exposing the porta hepatis, a part of the liver from which ducts and vessels enter and leave the organ. They do so by cutting away the damaged ducts and surrounding tissues right up to the liver capsule (the connective tissue surrounding the liver).
Roux-en-Y Hepaticojejunostomy
The Roux-en-Y procedure, commonly used for gastric bypass surgery, is used here to divert the flow of bile into the intestines. For this stage, the small intestine is severed just below the stomach, and the lower portion is attached to the liver capsule.
The upper portion is then looped around and reattached to the side of the lower portion so that the bile and contents of the stomach are fed into the same intestinal passageway. Once completed, surgical drains are placed inside the incision and held in place by an anchor suture. The abdominal wound is then closed with sutures or adhesive strips and bandaged.
After the Surgery
After the surgery, your child is wheeled into the post-anesthesia recovery unit (PACU) and monitored until they awaken from the anesthesia. Admission into the intensive care unit (ICU) may be needed, although this is less common today. The first two to three days, your child will not eat so that the internal wounds have a better chance of healing. Nutrition will instead be delivered either through a nasogastric tube or intravenously.
Recovery
It may take a while for the liver to fully heal and the bile flow to begin to normalize after the child is discharged from the hospital. During this period, daily oral antibiotics will be prescribed to prevent cholangitis. Since common infections can lead to cholangitis, frequent handwashing, routine vaccinations, and the avoidance of colds and flu is a must. Breastfeeding is typically recommended, since it provides types of fats that are easier for the liver to absorb.
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Survival with a native liver (not transplanted) ranges from 30-55 percent at 5 years of age; and 30-40 percent at 10 years of age. It is thought that approximately 80 percent of patients with biliary atresia will require liver transplantation by the age of 20.
Q. Why are babies born with liver problems?
Most likely they are caused by something that happened as the fetus was developing or around the time of birth. This might happen because of one or more of the following: A viral or bacterial infection after birth.
Q. Can biliary atresia be detected before birth?
Biliary atresia can't be detected by ultrasound during pregnancy and is usually discovered shortly after birth. Its cause is unknown. Bile has two main functions: it removes waste products from the liver and blood, and it's a necessary part of digestion.
Q. How do you know if your baby has liver problems?
It's important to be aware of the signs, which are: prolonged jaundice – yellowing of the skin and the whites of the eyes. Persistently pale-coloured baby poo, Yellow or dark yellow wee – a newborn baby's wee should be colourless.
Q.Can biliary atresia be cured?
Liver transplantation is the only cure for biliary atresia.
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