Surgical techniques in the management of distal biliary tract obstruction

Management of obstruction in the distal biliary tree requires the use of different techniques depending upon the cause of obstruction and numerous patient-risk variables. The techniques of choledochoduodenostomy, sphincteroplasty, and choledochojejunostomy are discussed. The common technical component in each of these procedures is the use of monofilament 4-0 polypropylene in a continuous, single-layer technique for all biliary-enteric suture lines. The ease of performance with these methods is emphasized.