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What Is the Kasai Procedure?

The Kasai procedure is an operation used to restore bile drainage in infants with biliary atresia. It is also called a Kasai portoenterostomy or hepatoportoenterostomy. The surgeon removes the damaged extrahepatic bile ducts and connects a loop of small intestine directly to the liver at the porta hepatis, where microscopic bile ductules can still drain. The procedure does not cure biliary atresia, but successful bile drainage can slow liver damage and delay the need for liver transplantation.

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What Is the Kasai Procedure?

The Kasai procedure is an operation used to restore bile drainage in infants with biliary atresia. It is also called a Kasai portoenterostomy or hepatoportoenterostomy. The surgeon removes the damaged extrahepatic bile ducts and connects a loop of small intestine directly to the liver at the porta hepatis, where microscopic bile ductules can still drain. The procedure does not cure biliary atresia, but successful bile drainage can slow liver damage and delay the need for liver transplantation.

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Why Is the Kasai Procedure Performed?

The procedure is the usual first surgical treatment for infants diagnosed with biliary atresia who are suitable for portoenterostomy. Biliary atresia blocks normal bile flow from the liver and can rapidly cause fibrosis, cirrhosis, portal hypertension, and liver failure without treatment. Earlier surgery is associated with a better chance of establishing bile drainage, so prompt diagnosis and referral are important. Some infants with advanced liver disease or failed drainage still require early liver transplantation.

How Is the Kasai Procedure Performed?

The surgeon explores the liver and bile ducts and removes the fibrotic extrahepatic biliary remnants that cannot carry bile normally. The tissue at the porta hepatis is carefully exposed to reach microscopic bile channels that can drain from the liver. A Roux-en-Y loop of jejunum is then connected directly to this surface to carry bile into the intestine. The reconstruction creates a new drainage route but does not rebuild normal extrahepatic bile ducts.

What Is Recovery Like After the Kasai Procedure?

Infants remain under close pediatric surgical and liver-specialist care after the operation while bile drainage, bilirubin levels, nutrition, growth, and liver function are monitored. Medications and nutritional support can be used to manage cholestasis, vitamin deficiencies, infection risk, and poor weight gain. Stool color and jaundice can improve when bile drainage becomes effective, although response is not immediate in every child. Long-term follow-up continues even after a successful Kasai because progressive liver disease can develop years later.

What Are the Risks and Complications?

Cholangitis is a major complication after the Kasai procedure because intestinal bacteria can travel through the reconstructed pathway toward the liver. Other problems include bleeding, bowel obstruction, poor bile drainage, persistent jaundice, nutritional deficiencies, and progressive liver scarring. Portal hypertension can develop and lead to an enlarged spleen, low platelets, ascites, or gastrointestinal varices. Many children eventually require liver transplantation despite technically successful portoenterostomy.

Frequently Asked Questions About the Kasai Procedure

Does the Kasai procedure cure biliary atresia?

No. It can restore bile drainage and slow liver damage, but biliary atresia remains a chronic liver disease and can still progress after surgery.

Why is the Kasai procedure performed early in infancy?

Earlier portoenterostomy is generally associated with better bile drainage because progressive inflammation and scarring reduce the chance of successful drainage over time.

What is cholangitis after a Kasai procedure?

Cholangitis is infection or inflammation of the bile-drainage system. It can cause fever, worsening jaundice, pale stools, poor feeding, or other signs of illness and requires prompt medical evaluation.

Can a child still need a liver transplant after Kasai surgery?

Yes. Many children eventually require liver transplantation because bile drainage is inadequate or chronic liver damage, portal hypertension, or other complications progress.

References

Treatment for Biliary Atresia. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/liver-disease/biliary-atresia/treatment. Date Accessed September 11, 2026.

Kasai Procedure: Surgery To Treat Biliary Atresia. Cleveland Clinic. https://my.clevelandclinic.org/health/procedures/kasai-procedure. Date Accessed September 11, 2026.

Biliary Atresia. Children's Hospital of Philadelphia. https://www.chop.edu/conditions-diseases/biliary-atresia. Date Accessed September 11, 2026.

Biliary Atresia. StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK537262/. Date Accessed September 11, 2026.

Management considerations and long-term outcomes in an aging population with biliary atresia. American Association for the Study of Liver Diseases. https://www.aasld.org/liver-fellow-network/core-series/clinical-pearls/management-considerations-and-long-term-outcomes. Date Accessed September 11, 2026.