How can biliary atresia be treated?
Biliary atresia is a rare disease of the liver and bile ducts. It presents very early in life and requires urgent treatment.
In newborns with biliary atresia, bile ducts are missing, incomplete, blocked or damaged. This stops the flow of bile from the liver to the gallbladder and small intestine. Bile backs up and gets trapped inside the liver.
The information on this page is for:
- Parents of babies and children with biliary atresia or suspected biliary atresia.
- Young people with biliary atresia.
- Family, friends, carers, and healthcare professionals.
There is no cure for biliary atresia and it cannot be treated with medicines. If tests show that your baby is very likely to have biliary atresia, they will need surgery as soon as possible. The operation needed for biliary atresia is called a Kasai procedure. This is named after the Japanese surgeon who first performed the operation in the 1950s.
Needing surgery so early in life can be a big shock for families. But it is very important that the operation is done as early as possible, because this will give your child the best chance of a good outcome. Remember – your hospital team and the Liver UK Children and Families team are here to support you every step of the way.
On this page:
Where will my child be treated?
Your baby will be treated at one of 3 paediatric liver centres in the UK:
- King’s College Hospital, London
- Birmingham Women’s and Children’s Hospital
- Leeds General Infirmary
Before the Kasai operation
Blood tests will be done and will include checking your baby’s blood group in case they need blood before, during or after surgery. Your baby may be given special medicines to prepare their gut for surgery.
Your baby will not be fed milk for a number of hours before the operation. The team caring for your baby will explain what this involves. If you are breast feeding and want to express and store milk, speak to your nursing team.
You will be allowed to go down to the operating theatre with your baby and stay until just before your baby is asleep.
Although it was extremely overwhelming, the team (at the hospital) did everything they could to put our worries at ease, my son’s health and happiness was always a priority and I felt confident his care was in the best hands
During the Kasai operation
The medical team will start the operation by carrying out an investigation called an intraoperative cholangiogram. This is done under general anaesthetic when your child has been put to sleep and will confirm the diagnosis of biliary atresia.
A cholangiogram is an X-ray that uses a special dye to show the bile ducts. It checks for blockages in bile ducts outside the liver.
If biliary atresia is confirmed, the surgical team will continue the operation with the Kasai procedure (also known as a Kasai portoenterostomy). This is usually done under the same general anaesthetic at the same time. The aim of the operation is to help restore bile flow by making a drainage tube that allows bile to drain from the liver into the gut.
During the operation, the gallbladder and all the damaged bile ducts outside the liver are removed. The surgeon finds smaller bile ducts along the surface of the liver that are still open and draining bile. They attach a loop of the baby’s own intestine to this part of the liver. This allows bile to flow from the remaining healthy bile ducts found inside the liver into the intestine.
During the operation, the surgeon will also check the liver for damage or other problems. They will take a tiny piece of the liver to send to the laboratory for further tests. This is called a wedge biopsy.
The Kasai procedure will last a whole morning or afternoon. Putting your baby to sleep, giving your child pain management and then waiting for your baby to wake up will take longer.
After the Kasai operation
You will be able to see your baby after surgery in the recovery area. There will be a tube going into your baby’s nose and down into their stomach. This is called a nasogastric tube. This usually drains into a clear bag and keeps your baby’s stomach empty, which helps prevent sickness. It is important to keep your baby’s stomach empty for 48-72 hours after surgery.
You will not be able to feed your baby for a couple of days. This is because the surgeon operates on the bowel, which stops it from working for a short time. When the bowel recovers, you can start feeding again. Until this time, your baby will be fed using an intravenous drip. This is where fluids and nutrients are put straight into your baby’s body through a vein.
It can be very emotional to see your baby after surgery. There will be lots of tubes and machines and this can feel very overwhelming. The medical team will explain what is happening and will answer any questions you may have. It will also be possible for you to hold your baby the day following the surgery.
Some commonly used devices you will see after surgery include:
Central line
A long, thin, hollow tube called a central line will be placed into one of the bigger blood vessels in your baby’s neck during surgery. This will be used to give your baby fluids, medicines, antibiotics and blood products if needed. It will be taken out when it is no longer needed.
Urinary catheter
Your baby will have a urinary catheter in place, which drains urine from the bladder. This helps the medical team measure the amount of urine your baby is making. It will tell them how well their kidneys are working.
Abdominal drain
Your baby may have an abdominal drain put in place during surgery. This drains excess wound fluid, blood or bile from around the liver. The drain will be removed as the amount of liquid reduces. A dressing will cover the wound on your baby’s tummy for the next few days. This will be changed as needed. The stitches do not need to be removed as they will dissolve after the wound has healed.
He had the Kasai procedure at eight weeks and has been doing brilliantly ever since. He always surprises the doctors and consultants when we have our check-ups as he is such a strong, vibrant and healthy boy who is much bigger than most of his friends at nursery!
Medicines
Medicines are used after the Kasai surgery to help with bile flow and to manage symptoms. The medicines used will be different for each baby and will depend on their condition and progress. The medical team will help you understand which medicines your baby needs to take and when.
Some commonly used medicines are:
Pain relieving medicines
Your baby will be given pain relief after surgery to keep them comfortable. Medicines are given via the central line or via a cannula (a tube inserted into a vein). A special pump controls the rate and amount of the medicines given.
Sometimes pain relief is given through a small tube inserted into your baby’s back at the time of the operation. This is similar to those used for women in labour. It is called an “epidural catheter”.
Antibiotics
Antibiotics are given after the Kasai procedure to reduce the risk of infection in the bile ducts (cholangitis). Your baby will be given antibiotics through a vein for 3-5 days after surgery. Further antibiotics may be given if needed.
Phenobarbital
This medicine may be used to help increase the flow of bile. It might make your baby sleepy at first, so it is usually given as a single dose in the evening.
URSO (Ursodeoxycholic acid)
URSO is a bile salt found naturally in small amounts in bile and helps to increase the flow of bile. Your baby may start taking this medicine before the Kasai operation. Or they may be given URSO when they start feeding again after surgery.
Steroids
Steroid medicines may be given for 4-6 weeks after surgery. They help to reduce inflammation and promote bile flow.
Vitamins
Poor bile flow can make it difficult for your baby to absorb vitamins from their feeds. They will be given vitamin supplements to help with this. This may be before or after the Kasai procedure.
Spironolactone
This medicine will be used if your baby needs help to get rid of extra fluid that has collected in their abdomen (ascites). It is not needed in all babies.
Anti-viral therapy
When doing tests for biliary atresia, the medical team sometimes find a virus called cytomegalovirus (CMV). This happens in around 10% of newborns with biliary atresia. The medical team may need to treat the virus with medicines that are put straight into your baby’s body through a vein. This will be a course of treatment lasting around 4-6 weeks. Your baby may have blood tests to check that the virus has cleared once they are home.
Other medicines may be prescribed in certain circumstances. Your hospital team will explain why these medicines are needed.
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This content was last reviewed: July 2026
Our expert reviewers:
We would like to thank everyone who helped with creating and reviewing this page. Including Professor Mark Davenport, Consultant Paediatric Surgeon, King’s College Hospital and Professor Deirdre Kelly, Professor of Paediatric Hepatology. And all our patient reviewers.
Find out how we make our patient information.
Everyone’s experience of liver disease will be different. Always talk to your specialist medical team for personal advice.
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