A technique for intrahepatic reconstruction of the biliary tree after complex high injuries is described. The fundament of the procedure is the removal of a wedge of segment IV at the level of the hilar plate. When the hilar plate is reached and no adequate exposure of the ducts can be obtained, removing a 1×1-in wedge of segment IV between the gallbladder bed and the round ligament exposes the left and right ducts. An anteroposterior view of the plate is obtained instead of a caudocephalic dissection, exposing healthy, nonscarred ducts for reconstruction. We have used this approach in 22 patients, and adequate exposure of the ducts has been obtained, with a high success rate of patency of the anastomosis at a mean follow-up of 3 years. Twenty patients have a patent anastomosis, with a good quality of life and no restenosis.
Transhepatic T tube in place for stenting of both ducts. Biliary junction is preserved.
Transhepatic T tube in place for stenting of both ducts without preserved biliary junction. After performing the right anastomosis, the short limb of the T tube is pulled out through a new opening in the jejunum to stent the left anastomosis.
Patency of the biliodigestive anastomosis is seen using T-tube cholangiography.
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