Should your baby have the Kasai Procedure? Let's talk about it simply.

You must have been very scared when the doctor told you that your little one's body is turning yellow and the reason is a blockage of the bile ducts in the liver, a condition called Biliary Atresia. Now the doctor is probably talking about a surgery called 'Kasai'. What exactly is this surgery? Will it be good for the baby? You must have many questions in your head. Don't worry. Let's talk about it very simply, in a way that you can understand.

What is the Kasai Procedure?

Simply put, this is a special surgery performed to treat a condition called Biliary Atresia . Our liver produces a fluid called 'bile'. This bile is what helps the body digest the fats and some vitamins in the food we eat and absorb them. In a baby with Biliary Atresia, the fine tubes (bile ducts) that carry bile from the liver to the intestines are blocked or not formed at birth.

So in this Kasai procedure, the surgeon removes these blocked, dysfunctional bile ducts. Then, they take a piece of the baby's own small intestine and connect it directly to the liver, creating a new pathway for bile to flow through. It's like removing a blocked pipe that's preventing water from flowing through and putting in a new one.

Why does a baby need this surgery?

Imagine, what happens when the bile coming from the liver has no way to get out? All that bile collects inside the liver. This accumulated bile gradually starts to damage the liver cells. Over time, the liver becomes injured, hardened, and unable to function. We call this cirrhosis .

This Kasai surgery stops or slows down the damage to the liver. This gives a great chance of saving the baby's life.

What happens before and during surgery?

Before surgery, doctors will give the baby IV fluids to keep him hydrated and give him antibiotics to reduce the risk of infection.

Before starting the surgery, the surgeon needs to be 100% sure that the baby has Biliary Atresia. This involves doing a test called a 'Cholangiogram' . In this, a small incision is made in the baby's abdomen, a small tube is inserted into the gallbladder, and a special medicine is injected that can be seen on an X-ray. This allows the doctor to clearly see if the bile duct is blocked or not.

If biliary atresia is confirmed, the doctor will proceed with surgery. The baby's gallbladder and the blocked bile ducts will be removed, and a new connection to the liver will be made using a section of the small intestine (jejunum). This surgery can take several hours.

What happens after the surgery?

After the surgery, the baby is kept in the intensive care unit (ICU) for about 5 to 10 days and is carefully cared for.

• Nutrition: No food is given for the first few days, to allow the wounds to heal. The necessary nutrition is given through saline. After that, milk is started through a nasogastric tube. Gradually, oral feeding is practiced.
• Observation: Doctors and nurses are watching the baby closely to see if there is any bleeding or if bile is being released. The baby's stools will turn yellow or green to indicate that bile has started to flow.
• Going home: You will be allowed to go home when the wounds start to heal, liver function improves, and the baby is able to breastfeed well.

How successful is the Kasai operation?

This is a very important question. The success of the surgery depends on several factors:

• Timing: This surgery is more likely to be successful if the baby is between 6 weeks and 2 months old . Therefore, it is very important to see a doctor as soon as you notice symptoms.
• Liver condition: If the damage to the liver is minimal at the time of surgery, the results are good.
• Medical team: It is also very important that the surgery is performed by a skilled surgeon and medical team who are experienced in these surgeries.

Under optimal conditions, this surgery can reduce symptoms, including jaundice, in more than 60% of babies. Doctors consider the surgery successful if the baby does not develop jaundice again within 6 months of the surgery.

What if the surgery wasn't successful?

Sometimes, even after a Kasai operation, the bile ducts may not drain properly. If that happens, the baby will need a liver transplant . Don't be alarmed by this. In fact, about half of babies who have a Kasai operation will need a liver transplant by the time they are 2 years old. A Kasai operation is a bridge to buy time until a liver transplant is needed.

How do you take care of your baby after bringing him home?

It may take about 3-4 months for the baby to fully recover. You need to be very careful about these things when taking care of the baby at home.

• Take your medications exactly as prescribed by your doctor, and at the right time. Oral antibiotics to prevent infections may need to be given for several months. Medications to improve bile flow may need to be given for years.
• Take care of the wound: Ask your doctor or nurse for specific instructions on how to clean the wound and what bandages to use.
• Don't miss the clinic: Be sure to go to the clinic on the scheduled days after the surgery. It is very important for the doctor to be constantly informed about the baby's recovery process.
• Breastfeeding is very important: If possible, breastfeed your baby. The fats in breast milk are easily absorbed by the liver. If breastfeeding is not possible, use a special formula recommended by your doctor.
• Stay clean: Always wash your hands thoroughly before touching your baby. Avoid contact with your baby if anyone in the family has a cold or fever.

I understand how shocked, sad, and scared you must be when you find out that your baby needs to go through something like this. When everything happens so quickly, you will definitely need help. Ask for help from your family, friends, and loved ones. Remember, you are not alone in this journey. Think about yourself on this journey too. Be hopeful, stay informed, and seek support from those around you.

Kasai Procedure, Biliary Atresia, Infantile Jaundice, Liver Disease, Bile Duct Obstruction, Liver Transplant