Injury to the common duct occurs most often in the middle third and is usually repaired by either a common duct-to-common duct (choledochocholedochostomy) or a biliary-intestinal anastomosis. Injuries occur less commonly in the proximal portion of the common duct, or even in the right and left hepatic ducts proximal to the jejunum. Repair of such sites is technically more difficult. Primary anastomosis between hepatic ducts and common duct if possible restores the normal anatomic pattern and preserves the sphincter mechanism that prevents regurgitation of intestinal content.
The senior author (W.W.) has used both hepatic ducts to repair biliary strictures 54 times in a total of 571 operations on the biliary tract.1 The types of repair performed in these 54 cases has been double hepaticoduodenostomy in 41, double hepaticocholedochostomy in 7, and double hepaticojejunostomy in 6.
The following case is reported to reveal the complications and also to describe the