Kasai Procedure: Preparation, Recovery, Long-Term Care

When to Stop

Solid food
6 hours before surgery

Formula milk
6 hours before surgery

Breast milk
4 hours before surgery

Clear fluids
1 hour before surgery

These guidelines can far minimize the gamble of pneumonic aspiration while reducing crave, anxiety, and temper in children awaiting surgery. Longer periods of fast may be needed for children with diabetes, cerebral paralysis, or gastroesophageal reflux disease .


There are a few medications used in infants that can pose damage if taken ahead surgery. In adults, for exemplify, nonsteroidal anti-inflammatory drugs ( NSAIDs ) like aspirin and Aleve ( naproxen ) are routinely avoided due to the risk of postoperative bleed, but these are not used in babies.

The only exception is Advil ( ibuprofen ), which can be used in children over 3 months. With that said, if Advil is needed to treat fever, the surgery will likely be postponed until the causal agent of the fever is identified and treated .

To avoid drug interactions, advise the surgeon about any medication your child is taking, whether it is prescription or over-the-counter .

What to Bring

As the parent or defender, you will need to bring some class of photograph ID ( such a driver ‘s license ) to check in at hospital admissions. You will besides need to bring your policy calling card or insurance documents showing that the child is on your plan or covered by government plans like the Children ‘s Health Insurance Program ( CHIP ) .

Because a Kasai routine requires an extend hospital stay, be indisputable to bring enough of your child ‘s medication to cover the sojourn, which the nurses will dispense along with any postoperative drugs .

You should besides bring your child ‘s front-runner blanket, toys, or a pacifier to help comfort them. For infants, the hospital will supply all of their casual manage needs, including diapers, food, and bottles .

What to Expect on the Day of Surgery

Parents are normally advised of the exact time of the operation a day or two in advance. By doing so, the hospital scheduler will have a better idea of the day ‘s schedule and avoid any backlogs that might lead to unnecessarily long waiting times .

After arrival, you will be asked to fill out medical history forms and sign a consent form stating that you understand the aims and risks of the surgery .

Before the surgery

once adjustment is complete, a surgical staff member will lead you and your child to a preoperative area, where a nurse will take your child ‘s weight and height ( which helps calculate the adjust anesthesia dose ) and vital signs ( including temperature, heart rate, and blood atmospheric pressure ) .

Your child is then prepped for operation either in a secret or semi-private room or cell. Because the preoperative procedures can be chilling and uncomfortable for children, the harbor may provide a mild ataractic to induce relaxation and prevent writhe or panic .

For the Kasai procedure, preoperative preparations will involve the surveil .

  • 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.

In some cases, a nasogastric tube may be inserted into the child ‘s nostril and fed into a stomach to deliver food after surgery. In addition to ensuring continuous nutrition, a nasogastric tube reduces atmospheric pressure on the inner wounds, hastens the refund of normal intestine function, and speeds recovery. Before surgery, you will meet with the anesthesiologist, who will ask about allergies or any adverse reaction your child may have had to anesthesia in the past. The anesthesiologist will besides explain the anesthesia operation and answer any questions you have .

Although you may or may not see the pediatric surgeon prior to the operation, a staff extremity will be on hand to keep you apprised of the progress and when your child will likely be wheeled to recovery .

During the Surgery

once the child prepped for operating room and wheeled into the surgical cortege, anesthesia is delivered. Depending on whether the surgery is open or laparoscopic, the choices include the keep up .

  • 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.” 

once the child has been anesthetized and vital signs are stable, the operating room can begin. There are two major stages to the Kasai procedure : biliary duct resection and Roux-en-Y hepaticojejunostomy .

Biliary Duct Resection

The surgeon starts by exposing the orifice hepatis, a separate of the liver from which ducts and vessels enter and leave the harmonium. 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, normally used for gastric beltway surgery, is used here to divert the flow of bile into the intestines. For this phase, the little intestine is severed just below the stomach, and the lower assign is attached to the liver-colored condensation .

The upper berth part is then looped around and reattached to the side of the lower fortune so that the bile and contents of the stomach are fed into the like intestinal passageway.

once completed, surgical drains are placed inside the incision and held in put by an anchor suture. The abdominal scent is then closed with sutures or adhesive material strips and bandaged .

After the operating room

After the operation, 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 of measurement ( ICU ) may be needed, although this is less common today .

Depending on the character of operating room used, you can expect your child to be hospitalized for anywhere from five to 10 days after the Kasai routine.

For the first two to three days, your child will not eat so that the internal wounds have a better find of healing. Nutrition will rather be delivered either through a nasogastric tube or intravenously. The child will be monitored for flatulence and intestine movements, both of which signal the return of normal intestinal routine .

In addition to pain medications and antibiotics, your child may be prescribed corticosteroid drugs ( a.k.a. steroids ) to reduce excitement and well up of the liver-colored. The treatment will typically need to be continued after fire .

The surgical drain will be removed once the drain stops, normally within three to five days of the surgery .


even after your child is discharged from the hospital, it may take a while for the liver to in full heal and the bile flow to begin to normalize .

During this period, casual oral antibiotics will be prescribed to prevent cholangitis. The treatment will likely be needed for a few months. Since common infections can lead to cholangitis, patronize handwash, act vaccinations, and the avoidance of colds and influenza is a must .

Your child will besides be placed on bile acid substitute medications like Cholbam ( cholic acerb ) that help improve bile flow. treatment will probably be needed for several years .

Breastfeeding is typically recommended, since it provides types of fats that are easier for the liver-colored to absorb. If you can not breastfeed, your surgeon will recommend a special formula that may be better tolerated than regular formula .

Proper wound wish is substantive to ensuring a quick convalescence .

When to Call a Doctor

Call your surgeon immediately if you notice any signs of infection or liver-colored dysfunction in the days and weeks following the surgery, including :

  • A high fever (100.4 F or over)
  • Increased redness, pain, or oozing from the wound
  • Confusion, extreme dizziness, or fainting
  • Abdominal swelling or pain
  • Unusual bruising or bleeding
  • No bowel movement for more than three days
  • Watery diarrhea for more than three days
  • Jaundice that returns or gets worse
  • Pale or white-color stools
  • Bloody stool or vomit

Follow-Up Care

once the surgery is arrant, it will take respective months before you know whether the Kasai procedure actually worked. During the first calendar month, it is not uncommon for the bile flow to remain moo, then gradually increase to normal or near-normal levels within a few months .

During this time, you will need to adhere to routine follow-up with your child ‘s gastroenterologist or hepatologist to monitor for any changes in the bile output or liver condition. The follow-up evaluations chiefly involve the follow .

  • Blood tests: Alkaline phosphatase, gamma-glutamyltransferase, and bilirubin are three liver functions tests that can help establish whether the biliary flow is improving or not.
  • Ultrasound elastography: This special ultrasound technique, also known as a FibroScan, is used to detect and measure liver fibrosis.

If the bile run does not improve—indicating treatment failure—liver transplant may be the only viable option. This will typically be performed before the child ‘s second gear birthday.

potential future Surgeries

flush if the Kasai operation is a success, there is a fairly firm likelihood that a liver-colored graft will be needed in the future. According to the american Liver Foundation, only around 25 % of children who undergo the Kasai operation will survive into their 20s without needing a transplant.

There are several actors that may improve the long-run prognosis. For case, children whose bitterness resolves within three months of the Kasai routine have a 75 % to 90 % prospect of surviving at least 10 years without a transplant.

By contrast, those who are treated late ( after 120 days ) have lone a 42 % luck of surviving for two years without a transplant, even if the Kasai procedure is initially successful.

The expectation for children undergoing a liver transplant is adept. All told, around 90 % will survive for at least five years, while 75 % will survive for 15 to 20 years with effective choice of life.

A Word From Verywell

As straiten as it may be to learn that your baby has bilious atresia, it is authoritative to remember that surgical techniques have improved enormously in recent years, as has the long-run management of liver disease after surgery .

prior to the introduction of the Kasai operation, children with biliary atresia rarely survived beyond their one-third year. today, those who have undergone the routine have been known to survive for 30 years without a transplant.

If your baby experiences bitterness or has persistent jaundice in the weeks following delivery, do not be swayed by people who might tell you that this is “ normal. ” While jaundice is newborns is not uncommon, it normally resolves within five days.

haunting jaundice is an wholly different issue and needs to be checked out immediately. If bilious atresia is involved, early diagnosis and treatment about always confer better results .

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