What Is a Kasai Procedure?

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  • Written By: Andy Josiah
  • Edited By: Nancy Fann-Im
  • Last Modified Date: 10 October 2019
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The term "Kasai procedure" refers to a surgical procedure applied to children suffering from biliary atresia. This is a rare ailment that involves a branch of medicine called hepatology, which concerns the liver and related organs such as the bladder and bile duct. The Kasai procedure is also known by its medical term, which is hepatoportoenterostomy.

In biliary atresia, the bile duct, a tube-like structure that transports the bile needed for digestion between the liver and the first section of the small intestine known as the duodenum, is missing or blocked. The disease is named after the biliary tree, of which the bile duct functions as the trunk. In cases where the bile is blocked, the person afflicted develops bile retention in the liver, or cholestasis. In either instance, ultimately, the lack of bile flow into the digestive tract leads to liver damage and failure, or jaundice, which is a yellowing of the skin and eyes. This condition is most severe among babies or infants, females, or people of Asian and African descent.


Without treatment, biliary atresia can cause death. The Kasai procedure is one of the most important ways of tackling the disease. The physician usually starts by removing the damaged bile ducts. Then part of the small intestine is attached to the portion of the liver that drains the bile, called the porta hepatis, or transverse fissure of the liver. This direct attachment to the liver restores a considerable level of bile flow function.

The sooner the Kasai procedure is performed, the better the prognosis might be for the patient. The surgical treatment is usually performed within the person’s first few months of life for the best results, particularly for the overall health of the liver. Research has shown that about 80 percent of children achieve significant bile drainage if the Kasai procedure is done within their first 60 days of life. Conversely, the later hepatoportoenterostomy is carried out, the less likely patients are able to achieve proper bile-drainage function.

The Kasai procedure has its share of complications. After the operation, it is likely that the patient may develop cholangitis and malabsorption. Cholangitis, which has a rather high mortality rate, refers to the inflammation of the bile ducts. The specific type of cholangitis that may arise from the Kasai procedure is usually caused by a bacterial infection called ascending cholangitis. Malabsorption refers to an abnormality of the absorption of nutrients from food in the gastrointestinal tract, of which the small intestine is a major component.


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