Kasai Procedure (Biliary Atresia Surgery) in India

The Kasai procedure (hepatoportoenterostomy) is an operation for babies born with biliary atresia, a rare condition in which the bile ducts outside the liver are blocked or missing, so bile cannot drain from the liver into the intestine. Without treatment, bile builds up and causes progressive liver scarring (cirrhosis) and liver failure. The Kasai operation creates a new drainage route by connecting a loop of intestine directly to the liver, and works best when performed as early as possible, ideally before 60 days of age. Indian centres with experienced paediatric hepatobiliary surgeons and paediatric liver transplant programmes offer the full pathway of diagnosis, Kasai surgery and long-term follow-up.

Cost of Kasai procedure in India starts from USD 7000 at leading JCI / NABH accredited hospitals. 10-14 days in hospital; total stay in India 3-4 weeks.

Final cost depends on the hospital, room category, doctor, implants/medicines used and the patient's medical condition. Share your reports with Satyug Healthcare for a free written estimate.

About the Procedure

• Biliary atresia affects roughly 1 in 10,000-20,000 newborns and is the most common reason for liver transplantation in children.
• Babies typically have jaundice lasting beyond 2-3 weeks of age, pale or clay-coloured stools, dark urine and, later, an enlarged liver.
• In the Kasai operation the blocked ducts are removed and a Roux-en-Y loop of small intestine is joined to the area at the base of the liver (porta hepatis) where tiny bile channels remain.
• When the operation is successful, bile starts to drain, stools become coloured and jaundice clears over the following weeks.
• Timing is critical: results are best when surgery is done within the first 60 days of life, although older infants may still benefit.
• Many children eventually need a liver transplant, but a successful Kasai can delay this for many years and some children keep their native liver into adulthood.

Purpose of the Procedure

• To restore the flow of bile from the liver into the intestine.
• To clear jaundice and allow normal digestion and absorption of fats and fat-soluble vitamins.
• To slow or prevent progressive liver scarring and cirrhosis.
• To allow the baby to grow and gain weight normally.
• To delay or avoid the need for liver transplantation in early childhood.
• To confirm the diagnosis of biliary atresia through an intra-operative cholangiogram and liver biopsy.

Diagnosis and Tests Before the Procedure

• Blood tests including total and direct (conjugated) bilirubin, liver enzymes, GGT, albumin and clotting profile.
• Stool colour monitoring, as persistently pale stools are an important warning sign.
• Abdominal ultrasound to look for an absent or abnormal gallbladder, the 'triangular cord' sign and associated anomalies such as polysplenia.
• Hepatobiliary (HIDA) scan to check whether bile reaches the intestine.
• Liver biopsy to look for features of bile duct obstruction.
• Tests to exclude other causes of neonatal cholestasis, such as infections, metabolic disorders, alpha-1 antitrypsin deficiency and Alagille syndrome.
• Intra-operative cholangiogram, which confirms the diagnosis at the start of surgery.
• Heart assessment (echocardiogram) because some babies have associated heart defects.

Step-by-Step Procedure

1. The baby is admitted for evaluation, vitamin K injections to correct clotting and optimisation of nutrition.
2. Under general anaesthesia given by a paediatric anaesthetist, the surgeon opens the abdomen through an incision under the ribs.
3. An intra-operative cholangiogram is performed by injecting dye into the gallbladder remnant to confirm that the ducts are blocked.
4. A liver biopsy is taken, and the fibrous remnants of the blocked bile ducts and gallbladder are removed up to the porta hepatis.
5. A Roux-en-Y loop of small intestine is prepared and joined to the porta hepatis so bile can drain directly into the bowel.
6. The intestine is reconnected, the abdomen is closed and the baby is moved to the paediatric or neonatal intensive care unit for monitoring.
7. Feeding is restarted gradually once bowel function returns, usually within a few days.
8. Medicines such as antibiotics to prevent cholangitis, ursodeoxycholic acid and, in many centres, steroids are started.
9. The baby is discharged after 10-14 days with nutritional supplements, fat-soluble vitamins and a follow-up plan.

Risks and Possible Complications

• Cholangitis (infection of the bile ducts), the most common complication, causing fever and returning jaundice; it needs prompt intravenous antibiotics.
• Failure of bile drainage, meaning jaundice does not clear and early liver transplantation is needed.
• Progression of liver scarring with portal hypertension, which can cause enlarged spleen and bleeding from varices.
• Poor growth and deficiency of vitamins A, D, E and K due to reduced fat absorption.
• Bleeding, wound infection or adhesions causing bowel obstruction.
• Risks of general anaesthesia in infants, which are minimised in specialised paediatric centres.
• Fluid in the abdomen (ascites) in some babies with advanced liver disease.

Your specialist will explain the risks specific to your condition. Choosing an experienced, high-volume hospital keeps complication rates low.

Recovery and Aftercare

• Most babies stay in hospital for 10-14 days, including a short stay in intensive care.
• Stools should gradually become yellow or green, and jaundice usually improves over 4-12 weeks if the operation is successful.
• A bilirubin level that returns to normal within about 3 months is a good sign for long-term outcome.
• Special formula containing MCT oil, fat-soluble vitamins and close monitoring of weight are important for growth.
• Parents are taught to watch for fever, pale stools or returning jaundice, which may signal cholangitis.
• Regular follow-up with a paediatric hepatologist continues for life, with blood tests and ultrasound to track liver health.
• Babies are usually fit to fly about 3-4 weeks after surgery, once feeding is established and the paediatric team has reviewed blood tests.

Why Choose India for Kasai procedure?

• JCI and NABH accredited hospitals with the latest medical technology
• Highly experienced specialists, many trained in the USA, UK and Europe
• Cost 60-80% lower than the USA, UK, Gulf countries and Singapore, with the same international-standard care
• No waiting lists - treatment can usually be scheduled within days of arrival
• Free end-to-end support from Satyug Healthcare: opinions, visa letter, airport pickup, interpreter and accommodation

Step-by-Step Process to Travel to India for Treatment

1. Share your reports - send your latest reports, scans/CD, angiography or echo films and passport copy to Satyug Healthcare on WhatsApp (+91-8860606766 / +91-9910655125) or email.
2. Free medical opinion & cost estimate - within 24-72 hours we share opinions and written cost estimates from 2-3 JCI/NABH-accredited hospitals and specialists.
3. Choose hospital & doctor - compare doctor experience, hospital, room category and total cost; we help you decide with no extra charge.
4. Visa Invitation Letter (VIL) - the hospital issues a VIL for the patient and up to two attendants; we arrange it within 24-48 hours.
5. Apply for Indian e-Medical Visa - apply online for the e-Medical Visa (patient) and e-Medical Attendant Visa (family) using the VIL; most approvals come in 3-5 working days.
6. Book flights & accommodation - we suggest flights and arrange a guest house, service apartment or hotel near the hospital to suit your budget.
7. Free airport pickup - our representative receives you at the airport and takes you to your hotel or directly to the hospital.
8. Hospital admission & treatment - a dedicated coordinator and language interpreter stay with you for registration, tests, doctor consultations, the procedure and billing.
9. Discharge & follow-up - you receive the discharge summary, prescriptions and fitness-to-fly certificate; follow-up checks are done before you fly.
10. Return home & tele-follow-up - we arrange airport drop and stay connected for online follow-up consultations with your doctor in India.

Contact Satyug Healthcare - International Patient Helpdesk: +91-8860606766 | +91-9910655125 (WhatsApp available) for a free medical opinion and cost estimate.