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Abstract
Anastomosis to the left hepatic duct approached by dissecting the hilar plate is the
most reliable method of drainage of the left side of the liver in that longitudinal
incision of the left hepatic duct allows a long cholangiojejunostomy. However, the
anatomy is not satisfactory in 30% of cases for adequate drainage of the left side
of the liver. To further clarify this surgically important area, 107 vasculobiliary
casts were reviewed with regard to the anatomy and relationship between the left biliary
ductal and left portal venous systems. In cases in which anatomy is unfavorable for
adequate drainage by anastomosis to the left hepatic duct in the hilum, several options
are available. The anterior portion of the main portal fissure may be opened to gain
wide access to the superior aspect of the biliary plate and reach a posterior duct
that is more suitable for anastomosis. An anastomosis to an anterior duct may also
be possible with this approach. If left portal ducts are inaccessible by division
of the main portal fissure because of a retroportal location, then an anastomosis
in the anterior portion of the umbilical fissure may give adequate drainage. Therefore
a cholangiogram is imperative before any anastomosis in the hilum or the anterior
portion of the umbilical fissure.
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References
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Blumgart LH, Kelley CG. Hepatico-jejunsotomy in benign and malignant high bile stricture: approaches to the left hepatic ducts. Br J Surg 1084;71:257–261.
Article info
Publication history
Accepted:
March 10,
1988
Identification
Copyright
© 1989 Published by Elsevier Inc.
