Thirty years' experience with biliary tract reconstruction by hepaticoenterostomy and transhepatic T tube

This study shows long-term results of biliary tract reconstruction in cases of high stenosis of the hepatic duct. Hepaticoenterostomy was performed with transhepatic insertion of a T tube following an original technique. A portion of the horizontal limb of the T tube is placed in the left hepatic duct, the other portion in the duodenum or jejunum, and the vertical limb extends into the right hepatic duct and the right lobe of the liver and is brought out through the abdominal wall. This tube is irrigated daily and removed after 12 months in order to keep the stent in place for a sufficient duration to prevent stenosis. This technique was used in 45 patients who underwent operations from 1954 to 1984. There were 6 postoperative deaths. Of the 39 patients discharged from the hospital, 37 were followed up. Excellent results were obtained in 30 patients who remained asymptomatic after observation from 1 to 14 years. In three patients, results were good, but there were occasional episodes of fever that subsided with antibiotics; one of these patients was observed for 17 years. Results were poor in four patients who developed a recurrent stenosis; three of them underwent reoperations, with satisfactory results. Long-term observation has shown that the described surgical procedure is useful in cases of high stenosis of the hepatic duct, because a stent can be left in place for a year and usually will prevent stenosis at the biliary intestinal anastomosis.