Bile ducts in these patients are almost completely blocked several months before surgery, and even after a successful
Kasai procedure, bile acid secretion in the liver does not reach normal levels within 6 to 12 months.
If the gallbladder was atretic, without a lumen, the incision was extended and
Kasai procedure was performed.
Many patients presented in advanced liver disease with liver dysfunction and portal hypertension, and the
Kasai procedure would not have improved their outcome, which is improved if surgery is performed before the age of 8 weeks.
Even at an older age, the
Kasai procedure was the treatment of choice.
Children with prolonged neonatal hepatitis should be investigated urgently, as the outcome of a
Kasai procedure for biliary atresia is poorer in older babies.
The only treatments recommended are the well known '
kasai procedure' or a liver transplant.
Our experience with the
Kasai procedure at King's College Hospital dates from this era.
(10,11) These cases are referred to as cystic biliary atresia and, likewise, have been postulated to form a distinct subgroup of patients whose prognoses were found to be more favorable in 1 study (11) but, as seen in BASM, may be more dependent on age at
Kasai procedure than perinatal biliary atresia.
Exploration was performed through a small right upper quadrant incision, planned to allow a subsequent
Kasai procedure if necessary.
(5,6) The current standard of care for BA is sequential surgical management with an initial
Kasai procedure (KP), in which the obstructed extrahepatic bile duct is resected and a loop of bowel is brought to the porta of the liver in an effort to restore bile flow, followed by liver transplantation (LT) for those cases that progress to liver failure.
Corrective surgery - the
Kasai procedure - is commonly used but it is not curative and leaves two-thirds of children needing a transplant, many before the age of two.
