Reconstruction of the biliary tract

The history of biliary reconstruction is a record of almost 100 years of surgical advancement. A reasonable technique is now available and applies not only to reconstruction after injury in the course of cholecystectomy but also to reconstruction after resection of tumor or in the treatment of sclerosing cholangitis, choledochocyst, or biliary calculi. A successful technique requires a dissection that does not compromise blood supply to the proximal duct, the use of a single layer of interrupted sutures, the temporary placement of a stent, and the use of bowel at the hilus of the liver without tension. As in most operative procedures the actual performance of the reconstruction is relatively easy in slender, good surgical subjects, but operative decisions and the actual technique used in locating the proximal duct and in suturing deep in the right upper quadrant can make reconstruction a difficult procedure.