[The topographic-anatomical starting point in reconstructive surgery on the choledochus]

Area of Science:

• Surgical Anatomy
• Gastrointestinal Surgery

Context:

• Reconstructive surgery of the common bile duct (CBD) is complex due to varied lesion locations and regional topography.
• Decision-making involves choosing between direct suture or biliodigestive anastomosis for CBD repair.

Purpose:

• To describe the topographic details crucial for reconstructive surgery of the common bile duct.
• To inform operative tactics based on lesion localization and anatomical considerations.

Summary:

• Operative tactics for CBD reconstruction hinge on lesion/stricture localization and regional anatomy.
• End-to-end anastomosis is favored for occlusions distant from the liver hilus, restoring physiological bile flow but risking late shrinkage.
• Choledochocholedochostomy without tension may involve mobilizing the terminal CBD from the pancreas.

Impact:

• Provides anatomical insights for optimizing surgical strategies in common bile duct reconstruction.
• Aids surgeons in selecting appropriate techniques for improved patient outcomes in CBD surgery.