KASAI SURGERY: INDICATIONS AND TECHNIQUES

Abstract

The Kasai procedure, or hepatoportoenterostomy, is a surgical procedure used in the treatment of biliary atresia in neonates. This congenital condition results in the obstruction of the bile ducts, leading to the accumulation of bile in the liver. The goal of the Kasai procedure is to restore bile flow by bypassing the obstruction. During the surgery, an anastomosis is created between the liver and a portion of the small intestine, allowing direct drainage of bile. The choice of a specific technique, such as the Y or H anastomosis, depends on the anatomical characteristics of the patient. Intraoperative examination, often assisted by cholangiography, is crucial to assess the permeability of the anastomosis. Although the Kasai procedure can be effective when performed early, its feasibility is contingent on the extent of the obstruction and the presence of complications. In cases where surgery is insufficient to maintain proper bile flow or when there is progression to advanced liver cirrhosis, liver transplantation becomes an important therapeutic alternative. This multidisciplinary approach, involving hepatologists, pediatric surgeons, specialized nurses, and other healthcare professionals, is essential for accurate diagnosis, the appropriate choice of surgical technique, and postoperative management. In summary, the Kasai procedure plays a crucial role in the treatment of biliary atresia, but its effectiveness is inherently linked to early intervention and collaboration among different medical specialties.