Surgery for Biliary Atresia in Children

There is no cure for biliary atresia, a progressive inflammatory condition that affects the ducts that transport bile—a substance that carries waste out of the liver and moves digestive enzymes to the small intestine. However, at Hassenfeld Children’s Hospital at NYU Langone, surgeons can perform a surgery called a Kasai procedure, or portoenterostomy, to restore the flow of bile and to prevent liver damage.

In some children, this surgery, along with medication, can prevent further injury in the bile ducts and liver. Other children may need long-term medication to reduce inflammation and improve digestion after surgery. Sometimes, a baby with biliary atresia needs a new liver. If the condition becomes life threatening, our experts can make referrals for liver transplantation.

During a Kasai procedure, the surgeon connects part of the small intestine directly to the liver to restore the flow of bile, bypassing the blocked bile ducts. This complex procedure is performed in the hospital while your baby receives general anesthesia. The surgery may take several hours to complete.

Your baby may remain in the hospital for a week or longer, so that doctors and nurses can look for signs that bile is flowing, such as darker stools and lighter urine, and monitor your child for any complications. These can include bleeding and cholangitis, an infection of the common bile duct, which drains bile from the liver to the intestine.

When performed before a baby is two or three months old, this procedure is often effective in restoring bile flow and preventing complications, such as scarring of the liver, a condition called cirrhosis. However, in many instances, biliary atresia continues to progress even after surgery restores the flow of bile. Our doctors may then prescribe medications to improve liver function.