Biliary atresia and Kasai procedure – A desperate race to save the liver!

Biliary atresia and Kasai procedure – A desperate race to save the liver!

A 2-month child, weighing just 4 kg, continuously increasing jaundice and a race against time to save the liver! This, in a nutshell, is the story of a child who was diagnosed with biliary atresia in Tanzania and operated successfully by our team.

What is Biliary atresia?
Biliary atresia is a condition in new born where bile outflow from liver is blocked due to narrow, blocked or absent bile ducts. As a result, the child develops jaundice since birth, which progressively increases and leads to liver failure, if intervention is not done in time. Such kids finally require liver transplant.

Can we prevent liver transplantation in biliary atresia?
Portoenterostomy, also known as kasai procedure, is a procedure to join viable, tiny, microscopic bile ducts with an intestinal loop of the infant, in order to provide an alternative drainage for bile, and prevent permanent liver damage.

Surgical challenges
The surgery needs to be done before the liver gets damaged by its own obstructed bile, generally before 4 months of age. So it is a race against time. The size of the biliary structures, and size and weight of the baby, are in themselves a major challenge in operating these kids. Secondly, the risk of infections in the bile ducts is quite high in such kids, which leads to blockage of the newly created drainage system after an initially successful surgery. Even if the surgery is successful, it generally takes 2-3 months for jaundice to disappear. So the surgery is technically challenging and failure rate is quite high reaching up to 50% of cases. Even with high chances of failure, this surgery is the only modality to save the native liver and prevent liver transplantation.

Our kid from Tanzania underwent Kasai procedure and is doing well. She has gained more than 2 kg weight in less than 2 months after surgery and her jaundice has come down significantly.