ALTHOUGH cirrhosis is a relatively uncommon complication of extrahepatic biliary obstruction,1 portal hypertension develops in a significant number of patients who have secondary biliary cirrhosis. Review of the records of 160 patients seen at the Mayo Clinic between January 1950, and July 1965, who were considered to have cirrhosis caused by extrahepatic biliary obstruction revealed 37 patients with demonstrable esophageal varices. This 23% incidence of portal hypertension complicating secondary cirrhosis is only approximate because the diagnosis of secondary cirrhosis was not verified anatomically, or histologically in all of the 160 cases, and because portal hypertension undoubtedly existed in many instances in which varices were not demonstrable. However, it is similar to the incidence reported by Sedgwick and associates,2 and by our medical colleagues3 in their review based on more critical diagnostic criteria.
Surgical management of this combination of disorders may be complicated by: (1) the presence of adhesions