Q. What is the outcome after the Kasai Porterostomy (PE) Operation?
A. After the Kasai operation, even though go bile flow may be established, the serum bilirubin levels may take up to 3-4 months to come to normal levels. The liver enzymes (especially alkaline phosphatase) will take much longer to turn to normal levels. We consider a portoenterostomy to be successful if the serum bilirubin is maintained at normal levels at 6 months after surgery. If, at 6 months post-op, the bilirubin remains below half of its preoperative level, the PE is considered to be partially successful. If there is no significant drop in bilirubin by 6 months, then the PE is considered to have failed.

Q. What is the long-term outcome after the Kasai operation?
A. Ten-year survival can be expected in up to 80% of patients who are jaundice-free after surgery. Those who do not clear their jaundice (unsuccessful operation) will require liver transplant for their early or late liver failure.

Of the 21 of Kasai's earlier successful patients, who are now over 20 years of age, 16 are well and asymptomatic while the others have features of chronic liver disease. The British Paediatric Association commissioned a study of all cases of biliary atresia born in UK and Ireland in 1994-1995. The study showed that the age at diagnosis in UK and Ireland is steadily improving. The current mean age at diagnosis was 53 days. The results of this study also confirmed the early finding of Mcclement et al that PE result are related to the experience of surgeon and center where surgery was performed and that PEs should be confined to centers performing at least 6 such operations per year.

Q. Is there a cut-off age for 'Successful' Kasai operation?
A. Recently several authors have challenged the earlier view that age at operation determines the outcome of PE. It is known that the exact time of onset and rate of progression of disease differs in each patient. Thus the most crucial factor responsible for the success of PE viz. the patency of the biliary remnants at the porta hepatis, is not age specific but patient specific. The 'cut-off' point for a success of operation of 60 days is arbitrary and coming from the statistical research that generated it.

Our data also reflects this fact. Interestingly, all our patients who have become jaundice - free after PE were operated after the so-called cut-off age of 60days. Also, like others, we have had successful results of Kasai at ages up to 120 days.

Of course, generally speaking, the best chance of a successful Kasai must be the first chance and the earlier the operation is performed the better it is.