OF THE numerous methods of repair of defects of the bile ducts, the two which are generally considered most dependable are direct end to end anastomosis of the distal and proximal segments of the duct and anastomosis of the proximal portion to the duodenum or jejunum. The first of these procedures is obviously the method of choice and, when the defect is short, is usually applicable. For strictures limited to the ampullary region with dilatation of the duct above, a choledochoduodenostomy or choledochojejunostomy affords an effective and physiologic means of overcoming the obstruction.
In the presence of extensive destruction of the ducts, the problem is far more serious. Within recent years, hepaticojejunostomy with a supplementary enteroenterostomy, as suggested by Allen1 and by Warren Cole,2 has gained wide acceptance as a logical solution. After these procedures, however, one is confronted with the possibility of stricture at the site of