Table of ContentsView AllTable of ContentsWhat It IsPurposeHow to PrepareWhat to ExpectRecovery
Table of ContentsView All
View All
Table of Contents
What It Is
Purpose
How to Prepare
What to Expect
Recovery
If left untreated, the condition, called biliary atresia, can cause severe liver damage due to the backflow of bile. The Kasai procedure is considered the first-line treatment of biliary atresia.
Although it does not cure the condition, it can slow the progression of liver injury. Even so, many children who have undergone the Kasai procedure will eventually need aliver transplant, even if the surgery is considered successful.
Surgery is the only reliable means to treat biliary atresia.
Jim Champion/ Flickr Creative Commons
What Is the Kasai Procedure?
The causes of biliary atresia are not clear. For some children, this condition may occur because the bile ducts did not develop normally during pregnancy. Other possible causes may include:
The Kasia procedure is aninpatient surgeryused in the first-line treatment of biliary atresia. It involves the removal of the damaged bile ducts andgallbladder(the pear-shaped organ that stores and releases bile), after which a segment of the child’ssmall intestineis sewn to the liver to restore the bile flow.
The Kasai procedure can either be performed as anopen surgery(involving a large incision) or a minimally invasivelaparoscopic surgery(involving smaller “keyhole” incisions and specialized narrow instruments).
The Kasai procedure is performed as a matter of urgency. It is not a definitive cure, but can often normalize the bile flow and minimize damage to the liver, often for decades.
Indications for Surgery
The Kasai procedure is performed upon the diagnosis of biliary atresia. There are no contraindications for treatment.
If left untreated, biliary atresia can become life-threatening within months or years, leading to liver fibrosis (scarring),cirrhosis,liver failure, and death. Current research suggests that the three-year survival rate for untreated children is less than 10%. With treatment, many children with biliary atresia can survive well into adulthood.
How Biliary Obstruction Is Diagnosed
Potential Risks
The risks of the Kasai procedure are not unlike that of any other surgery and may include pain, postoperative infection, and an adverse reaction to theanesthesia.
With the Kasai procedure specifically, there are other potential risks, including the following.
What Is Biliary Dyskinesia?
Purpose of the Kasai Procedure
The Kasai procedure is performed as soon as biliary atresia is diagnosed. The surgery should not be delayed, as doing so can increase the risk of complications and treatment failure.
The diagnosis of biliary atresia is not always straightforward, in part because the disorder is often indistinguishable from neonatal jaundice, a usually harmless condition that affects as many as 80% of preterm babies and 60% of full-term babies.
Doctors will often suspect biliary atresia when the following cascade of symptoms develops within two and six weeks of birth:
Biliary atresia can be confirmed with a combination of a physical exam,liver function tests, anabdominal ultrasound, and a liverbiopsy. These procedures can all be performed within a matter of days.
As with any disease, the success of the Kasai procedure depends on numerous factors, including thestage of fibrosisprior to surgery, the degree of biliary impairment, the general health of the child, and the degree of post-surgical bile flow.
A 2015 study published inJournal of Pediatricsreported that survival for those with biliary atresia who underwent a Kasai with their own liver (without needing a transplant) was approximately 87% at 5 years, 77% at 10 years, and 48% at 15 years.
Being faced with any pediatric surgery can be stressful, but knowing what to expect can help ease some of the anxiety.
Location
The Kasai procedure is performed in the operating room of a hospital. Because it is a specialized procedure, it is often performed in a dedicated children’s hospital equipped with anesthesia machines,mechanical ventilators, and surgical equipment specially designed for infants, babies, and young children.
Food and Drink
The food and drink restrictions for surgery in children are not as complex as those of adults, but still need to be strictly adhered to. Fasting helps prevent the risk ofpulmonary aspiration, in which food is accidentally vomited into the lungs.
Although the risk of pulmonary aspiration is low in babies (only around 0.1%), parents will still be instructed to stop the following foods in the hours leading up to the surgery:
These guidelines can further minimize the risk of pulmonary aspiration while reducing thirst, anxiety, and irritability in children awaiting surgery. Longer periods of fasting may be needed for children withdiabetes,cerebral palsy, orgastroesophageal reflux disease.
Medications
There are a few medications used in infants that can pose harm if taken before surgery. In adults, for instance,nonsteroidal anti-inflammatory drugs (NSAIDs)likeaspirinandAleve (naproxen)are routinely avoided due to the risk of postoperative bleeding, but these are not used in babies.
The only exception is Advil (ibuprofen), which can be used in children over 6 months. With that said, if Advil is needed to treat fever, the surgery will likely be postponed until the cause of the fever is identified and treated.
To avoid drug interactions, advise the surgeon about any medication your child is taking, whether it is prescription or over-the-counter.
What to Bring
Because a Kasai procedure requires an extended hospital stay, be sure to bring enough of your child’s medication to cover the visit, which the nurses will dispense along with any postoperative drugs.
You should also bring your child’s favorite blanket, toys, or a pacifier to help comfort them. For infants, the hospital will supply all of their daily care needs, including diapers, food, and bottles.
What to Expect on the Day of Surgery
Parents are usually advised of the exact time of the surgery a day or two in advance. By doing so, the hospital scheduler will have a better idea of the day’s schedule and avoid any backlogs that might lead to unnecessarily long waiting times.
After arrival, you will be asked to fill out medical history forms and sign a consent form stating that you understand the aims and risks of the surgery.
Before the Surgery
Once registration is complete, a surgical staff member will lead you and your child to a preoperative area, where a nurse will take your child’s weight and height (which helps calculate the correct anesthesia dose) andvital signs(including temperature, heart rate, and blood pressure).
Your child is then prepped for surgery either in a private or semi-private room or cubicle. Because the preoperative procedures can be scary and uncomfortable for children, the nurse may provide a mild sedative to induce relaxation and prevent squirming or panic.
For the Kasai procedure, preoperative preparations will involve the following.
In some cases, anasogastric tubemay be inserted into the child’s nostril and fed into a stomach to deliver food after surgery. In addition to ensuring continuous nutrition, a nasogastric tube reduces pressure on the internal wounds, hastens the return of normal bowel function, and speeds recovery.
Before surgery, you will meet with theanesthesiologist, who will ask about allergies or any adverse reaction your child may have had to anesthesia in the past. The anesthesiologist will also explain the anesthesia procedure and answer any questions you have.
Although you may or may not see the pediatric surgeon prior to the surgery, a staff member will be on hand to keep you apprised of the progress and when your child will likely be wheeled to recovery.
What Are the Risks of General Anesthesia?
During the Surgery
Once the child prepped for surgery and wheeled into the surgical suite, anesthesia is delivered. Depending on whether the surgery is open or laparoscopic, the choices include the following.
Once the child has been anesthetized and vital signs are stable, the surgery can begin. There are two major stages to the Kasai procedure: biliary duct resection and Roux-en-Y hepaticojejunostomy.
Biliary Duct Resection
Roux-en-Y Hepaticojejunostomy
The upper portion is then looped around and reattached to thesideof the lower portion so that the bile and contents of the stomach are fed into the same intestinal passageway.
After the Surgery
After the surgery, your child is wheeled into thepost-anesthesia recovery unit (PACU)and monitored until they awaken from the anesthesia. Admission into theintensive care unit (ICU)may be needed, although this is less common today.
Depending on the type of surgery used, you can expect your child to be hospitalized for anywhere from five to 10 days after the Kasai procedure.
For the first few days after the procedure, your child may not eat so that the internal wounds have a better chance of healing. Nutrition will instead be delivered either through a nasogastric tube orintravenously. The child will be monitored for flatulence and bowel movements, both of which signal the return of normal intestinal function.
Your child will likely be prescribed pain medications and antibiotics.
The surgical drain will be removed once the drainage stops, usually within three to five days of the surgery.
Passing Gas After Abdominal or Other Types of Surgery
Even after your child is discharged from the hospital, it may take a while for the liver to fully heal and the bile flow to begin to normalize.
During this period, daily oral antibiotics will be prescribed to prevent cholangitis. The treatment will likely be needed for a few months. Since common infections can lead to cholangitis,frequent handwashing,routine vaccinations, and the avoidance of colds and flu is a must.
Your child will also be placed onbile acid replacement medicationslike Cholbam (cholic acid) that help improve bile flow. Treatment will likely be needed for several years.
Breastfeeding is typically recommended, since it provides types of fats that are easier for the liver to absorb. If you cannot breastfeed, your surgeon will recommend a special formula that may be better tolerated than regular formula.
Proper wound careis essential to ensuring a speedy recovery.
When to Call a DoctorCall your surgeon immediately if you notice any signs of infection or liver dysfunction in the days and weeks following the surgery, including:A high fever (100.4 F or over)Increased redness, pain, or oozing from the woundConfusion, extreme dizziness, or faintingAbdominal swelling or painUnusual bruising or bleedingNo bowel movement for more than three daysWatery diarrhea for more than three daysJaundice that returns or gets worsePale or white-color stoolsBloody stool or vomit
When to Call a Doctor
Call your surgeon immediately if you notice any signs of infection or liver dysfunction in the days and weeks following the surgery, including:A high fever (100.4 F or over)Increased redness, pain, or oozing from the woundConfusion, extreme dizziness, or faintingAbdominal swelling or painUnusual bruising or bleedingNo bowel movement for more than three daysWatery diarrhea for more than three daysJaundice that returns or gets worsePale or white-color stoolsBloody stool or vomit
Call your surgeon immediately if you notice any signs of infection or liver dysfunction in the days and weeks following the surgery, including:
How to Prevent Postoperative Infection
Once the surgery is complete, it will take several months before you know whether the Kasai procedure actually worked. During the first month, it is not uncommon for the bile flow to remain low, then gradually increase to normal or near-normal levels within a few months.
During this time, you will need to adhere to routine follow-up with your child’sgastroenterologist or hepatologistto monitor for any changes in the bile output or liver status. The follow-up evaluations mainly involve the following.
If the bile flow does not improve—indicating treatment failure—liver transplantation may be the only viable option. This will typically be performed before the child’s second birthday.
How to Know If a Liver Transplant Is Needed
Possible Future Surgeries
Even if the Kasai procedure is a success, there is a fairly strong likelihood that a liver transplant will be needed in the future. According to the American Liver Foundation, only around 25% of children who undergo the Kasai procedure will survive into their 20s without needing a transplant.
There are several actors that may improve the long-term prognosis. For instance, children whose jaundice resolves within three months of the Kasai procedure have a 75% to 90% chance of surviving at least 10 years without a transplant.
By contrast, those who are treated late (after 120 days) have only a 42% chance of surviving for two years without a transplant, even if the Kasai procedure is initially successful.
The outlook for children undergoing a liver transplant is good. One 2016 study published inJournal of Pediatric Gastroenterology & Nutritionfound thatpatients undergoing transplant when they were under the age of two had a five-year survival of 93.8%, compared with 97.1% for those who who received a transplant after two years of age.
How to Qualify for a Liver Transplant
A Word From Verywell
As distressing as it may be to learn that your infant has biliary atresia, it is important to remember that surgical techniques have improved enormously in recent years, as has the long-term management of liver disease after surgery.
Prior to the introduction of the Kasai procedure, children with biliary atresia rarely survived beyond their third year. Today, those who have undergone the procedure have been known to survive for 30 years with a transplant.
Persistent jaundice is an entirely different issue and needs to be checked out immediately. If biliary atresia is involved, early diagnosis and treatment almost always confer better results.
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dunn SP.Biliary atresia and biliary hypoplasia. In: Shackelford’s Surgery of the Alimentary Tract, Volume 2 (Eighth Edition).Garcia AV, Cowles RA, Kato T, Hardy MA.Morio Kasai: A remarkable impact beyond the Kasai procedure.J Pediatr Surg. 47(5):1023-7. doi:10.1016/j.jpedsurg.2012.01.065National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of biliary atresia.Huang SY, Yeh CM, Chen HC, Chou CM.Reconsideration of laparoscopic Kasai operation for biliary atresia.J Laparoendosc Adv Surg Tech A. 28(2):229-34. doi:10.1089/lap.2017.0535Siddiqui AI, Ahman T.Biliary atresia. StatPearls.Brits H, Adendorff J, Huisamen D, et al.The prevalence of neonatal jaundice and risk factors in healthy term neonates at National District Hospital in Bloemfontein.Afr J Prim Health Care Fam Med. 10(1):e1-e6. doi:10.4102/phcfm.v10i1.1582Lakshminarayanan B, Davenport M.Biliary atresia: A comprehensive review.J Autoimmun. 73:1-9. doi:10.1016/j.jaut.2016.06.005Gu YH, Yokoyama K, Mizuta K, et al.Stool color card screening for early detection of biliary atresia and long-term native liver survival: A 19-year cohort study in Japan.The Journal of Pediatrics. 2015;166(4):897-902.e1. doi:10.1016/j.jpeds.2014.12.063Thomas M, Morrison C, Newton R, Schindler E.Consensus statement on clear fluids fasting for elective pediatric general anesthesia.Paediatr Anaesth. 28(5):411-4. doi:10.1111/pan.13370Sullivan JS, Sundaram SS, Pan Z, Sokol RJ.Parenteral nutrition supplementation in biliary atresia patients listed for liver transplantation.Liver Transpl. 18(1):120-8. doi:10.1002/lt.22444Rahimzadeh P, Safari S, Faiz SH, Alavian SM.Anesthesia for patients with liver disease.Hepat Mon. 14(7):e19881. doi:10.5812/hepatmon.19881Gao JB, Bai LS, Hu ZJ, Wu JW, Chai XQ.Role of Kasai procedure in surgery of hilar bile duct strictures.World J Gastroenterol. 17(37):4231-4. doi:10.3748/wjg.v17.i37.4231Hofmann AF.Bile acid replacement in bile acid synthesis defects.J Pediatr Gastroenterol Nutr. 65(6):e134. doi:10.1097/MPG.0000000000001709Ure BM, Kuebler JF, Schukfeh N, Engelmann C, Dingemann J, Petersen C.Survival with the native liver after laparoscopic versus conventional Kasai portoenterostomy in infants with biliary atresia: A prospective trial.Ann Surg. 253(4):826-30. doi:10.1097/SLA.0b013e318211d7d8American Liver Foundation.Biliary atresia.Sundaram SS, Mack CL, Feldman AG, Sokol RJ.Biliary atresia: Indications and timing of liver transplantation and optimization of pretransplant care.Liver Transpl. 23(1):96-109. doi:10.1002/lt.24640Arnon R, Annunziato RA, D’Amelio G, Chu J, Shneider BL.Liver transplantation for biliary atresia: is there a difference in outcome for infants?Journal of Pediatric Gastroenterology & Nutrition. 2016;62(2):220-225. doi:10.1097/MPG.0000000000000986Kobayashi T, Miura K, Kubota M, et al.Living donor liver transplantation for more than 30-year survived patients with native liver after Kasai operation for biliary atresia.Transplantation Reports.5(3):100052. doi:10.1016/j.tpr.2020.100052American Academy of Family Physicians.Infant jaundice.
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dunn SP.Biliary atresia and biliary hypoplasia. In: Shackelford’s Surgery of the Alimentary Tract, Volume 2 (Eighth Edition).Garcia AV, Cowles RA, Kato T, Hardy MA.Morio Kasai: A remarkable impact beyond the Kasai procedure.J Pediatr Surg. 47(5):1023-7. doi:10.1016/j.jpedsurg.2012.01.065National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of biliary atresia.Huang SY, Yeh CM, Chen HC, Chou CM.Reconsideration of laparoscopic Kasai operation for biliary atresia.J Laparoendosc Adv Surg Tech A. 28(2):229-34. doi:10.1089/lap.2017.0535Siddiqui AI, Ahman T.Biliary atresia. StatPearls.Brits H, Adendorff J, Huisamen D, et al.The prevalence of neonatal jaundice and risk factors in healthy term neonates at National District Hospital in Bloemfontein.Afr J Prim Health Care Fam Med. 10(1):e1-e6. doi:10.4102/phcfm.v10i1.1582Lakshminarayanan B, Davenport M.Biliary atresia: A comprehensive review.J Autoimmun. 73:1-9. doi:10.1016/j.jaut.2016.06.005Gu YH, Yokoyama K, Mizuta K, et al.Stool color card screening for early detection of biliary atresia and long-term native liver survival: A 19-year cohort study in Japan.The Journal of Pediatrics. 2015;166(4):897-902.e1. doi:10.1016/j.jpeds.2014.12.063Thomas M, Morrison C, Newton R, Schindler E.Consensus statement on clear fluids fasting for elective pediatric general anesthesia.Paediatr Anaesth. 28(5):411-4. doi:10.1111/pan.13370Sullivan JS, Sundaram SS, Pan Z, Sokol RJ.Parenteral nutrition supplementation in biliary atresia patients listed for liver transplantation.Liver Transpl. 18(1):120-8. doi:10.1002/lt.22444Rahimzadeh P, Safari S, Faiz SH, Alavian SM.Anesthesia for patients with liver disease.Hepat Mon. 14(7):e19881. doi:10.5812/hepatmon.19881Gao JB, Bai LS, Hu ZJ, Wu JW, Chai XQ.Role of Kasai procedure in surgery of hilar bile duct strictures.World J Gastroenterol. 17(37):4231-4. doi:10.3748/wjg.v17.i37.4231Hofmann AF.Bile acid replacement in bile acid synthesis defects.J Pediatr Gastroenterol Nutr. 65(6):e134. doi:10.1097/MPG.0000000000001709Ure BM, Kuebler JF, Schukfeh N, Engelmann C, Dingemann J, Petersen C.Survival with the native liver after laparoscopic versus conventional Kasai portoenterostomy in infants with biliary atresia: A prospective trial.Ann Surg. 253(4):826-30. doi:10.1097/SLA.0b013e318211d7d8American Liver Foundation.Biliary atresia.Sundaram SS, Mack CL, Feldman AG, Sokol RJ.Biliary atresia: Indications and timing of liver transplantation and optimization of pretransplant care.Liver Transpl. 23(1):96-109. doi:10.1002/lt.24640Arnon R, Annunziato RA, D’Amelio G, Chu J, Shneider BL.Liver transplantation for biliary atresia: is there a difference in outcome for infants?Journal of Pediatric Gastroenterology & Nutrition. 2016;62(2):220-225. doi:10.1097/MPG.0000000000000986Kobayashi T, Miura K, Kubota M, et al.Living donor liver transplantation for more than 30-year survived patients with native liver after Kasai operation for biliary atresia.Transplantation Reports.5(3):100052. doi:10.1016/j.tpr.2020.100052American Academy of Family Physicians.Infant jaundice.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Dunn SP.Biliary atresia and biliary hypoplasia. In: Shackelford’s Surgery of the Alimentary Tract, Volume 2 (Eighth Edition).Garcia AV, Cowles RA, Kato T, Hardy MA.Morio Kasai: A remarkable impact beyond the Kasai procedure.J Pediatr Surg. 47(5):1023-7. doi:10.1016/j.jpedsurg.2012.01.065National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of biliary atresia.Huang SY, Yeh CM, Chen HC, Chou CM.Reconsideration of laparoscopic Kasai operation for biliary atresia.J Laparoendosc Adv Surg Tech A. 28(2):229-34. doi:10.1089/lap.2017.0535Siddiqui AI, Ahman T.Biliary atresia. StatPearls.Brits H, Adendorff J, Huisamen D, et al.The prevalence of neonatal jaundice and risk factors in healthy term neonates at National District Hospital in Bloemfontein.Afr J Prim Health Care Fam Med. 10(1):e1-e6. doi:10.4102/phcfm.v10i1.1582Lakshminarayanan B, Davenport M.Biliary atresia: A comprehensive review.J Autoimmun. 73:1-9. doi:10.1016/j.jaut.2016.06.005Gu YH, Yokoyama K, Mizuta K, et al.Stool color card screening for early detection of biliary atresia and long-term native liver survival: A 19-year cohort study in Japan.The Journal of Pediatrics. 2015;166(4):897-902.e1. doi:10.1016/j.jpeds.2014.12.063Thomas M, Morrison C, Newton R, Schindler E.Consensus statement on clear fluids fasting for elective pediatric general anesthesia.Paediatr Anaesth. 28(5):411-4. doi:10.1111/pan.13370Sullivan JS, Sundaram SS, Pan Z, Sokol RJ.Parenteral nutrition supplementation in biliary atresia patients listed for liver transplantation.Liver Transpl. 18(1):120-8. doi:10.1002/lt.22444Rahimzadeh P, Safari S, Faiz SH, Alavian SM.Anesthesia for patients with liver disease.Hepat Mon. 14(7):e19881. doi:10.5812/hepatmon.19881Gao JB, Bai LS, Hu ZJ, Wu JW, Chai XQ.Role of Kasai procedure in surgery of hilar bile duct strictures.World J Gastroenterol. 17(37):4231-4. doi:10.3748/wjg.v17.i37.4231Hofmann AF.Bile acid replacement in bile acid synthesis defects.J Pediatr Gastroenterol Nutr. 65(6):e134. doi:10.1097/MPG.0000000000001709Ure BM, Kuebler JF, Schukfeh N, Engelmann C, Dingemann J, Petersen C.Survival with the native liver after laparoscopic versus conventional Kasai portoenterostomy in infants with biliary atresia: A prospective trial.Ann Surg. 253(4):826-30. doi:10.1097/SLA.0b013e318211d7d8American Liver Foundation.Biliary atresia.Sundaram SS, Mack CL, Feldman AG, Sokol RJ.Biliary atresia: Indications and timing of liver transplantation and optimization of pretransplant care.Liver Transpl. 23(1):96-109. doi:10.1002/lt.24640Arnon R, Annunziato RA, D’Amelio G, Chu J, Shneider BL.Liver transplantation for biliary atresia: is there a difference in outcome for infants?Journal of Pediatric Gastroenterology & Nutrition. 2016;62(2):220-225. doi:10.1097/MPG.0000000000000986Kobayashi T, Miura K, Kubota M, et al.Living donor liver transplantation for more than 30-year survived patients with native liver after Kasai operation for biliary atresia.Transplantation Reports.5(3):100052. doi:10.1016/j.tpr.2020.100052American Academy of Family Physicians.Infant jaundice.
Dunn SP.Biliary atresia and biliary hypoplasia. In: Shackelford’s Surgery of the Alimentary Tract, Volume 2 (Eighth Edition).
Garcia AV, Cowles RA, Kato T, Hardy MA.Morio Kasai: A remarkable impact beyond the Kasai procedure.J Pediatr Surg. 47(5):1023-7. doi:10.1016/j.jpedsurg.2012.01.065
National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of biliary atresia.
Huang SY, Yeh CM, Chen HC, Chou CM.Reconsideration of laparoscopic Kasai operation for biliary atresia.J Laparoendosc Adv Surg Tech A. 28(2):229-34. doi:10.1089/lap.2017.0535
Siddiqui AI, Ahman T.Biliary atresia. StatPearls.
Brits H, Adendorff J, Huisamen D, et al.The prevalence of neonatal jaundice and risk factors in healthy term neonates at National District Hospital in Bloemfontein.Afr J Prim Health Care Fam Med. 10(1):e1-e6. doi:10.4102/phcfm.v10i1.1582
Lakshminarayanan B, Davenport M.Biliary atresia: A comprehensive review.J Autoimmun. 73:1-9. doi:10.1016/j.jaut.2016.06.005
Gu YH, Yokoyama K, Mizuta K, et al.Stool color card screening for early detection of biliary atresia and long-term native liver survival: A 19-year cohort study in Japan.The Journal of Pediatrics. 2015;166(4):897-902.e1. doi:10.1016/j.jpeds.2014.12.063
Thomas M, Morrison C, Newton R, Schindler E.Consensus statement on clear fluids fasting for elective pediatric general anesthesia.Paediatr Anaesth. 28(5):411-4. doi:10.1111/pan.13370
Sullivan JS, Sundaram SS, Pan Z, Sokol RJ.Parenteral nutrition supplementation in biliary atresia patients listed for liver transplantation.Liver Transpl. 18(1):120-8. doi:10.1002/lt.22444
Rahimzadeh P, Safari S, Faiz SH, Alavian SM.Anesthesia for patients with liver disease.Hepat Mon. 14(7):e19881. doi:10.5812/hepatmon.19881
Gao JB, Bai LS, Hu ZJ, Wu JW, Chai XQ.Role of Kasai procedure in surgery of hilar bile duct strictures.World J Gastroenterol. 17(37):4231-4. doi:10.3748/wjg.v17.i37.4231
Hofmann AF.Bile acid replacement in bile acid synthesis defects.J Pediatr Gastroenterol Nutr. 65(6):e134. doi:10.1097/MPG.0000000000001709
Ure BM, Kuebler JF, Schukfeh N, Engelmann C, Dingemann J, Petersen C.Survival with the native liver after laparoscopic versus conventional Kasai portoenterostomy in infants with biliary atresia: A prospective trial.Ann Surg. 253(4):826-30. doi:10.1097/SLA.0b013e318211d7d8
American Liver Foundation.Biliary atresia.
Sundaram SS, Mack CL, Feldman AG, Sokol RJ.Biliary atresia: Indications and timing of liver transplantation and optimization of pretransplant care.Liver Transpl. 23(1):96-109. doi:10.1002/lt.24640
Arnon R, Annunziato RA, D’Amelio G, Chu J, Shneider BL.Liver transplantation for biliary atresia: is there a difference in outcome for infants?Journal of Pediatric Gastroenterology & Nutrition. 2016;62(2):220-225. doi:10.1097/MPG.0000000000000986
Kobayashi T, Miura K, Kubota M, et al.Living donor liver transplantation for more than 30-year survived patients with native liver after Kasai operation for biliary atresia.Transplantation Reports.5(3):100052. doi:10.1016/j.tpr.2020.100052
American Academy of Family Physicians.Infant jaundice.
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