Hepaticojejunostomy in benign and malignant high bile duct stricture: approaches to the left hepatic ducts

Biliary-enteric anastomosis for relief of biliary obstruction caused by benign or malignant disease at the confluence of the bile ducts can be difficult. An approach by dissection at the confluence has to be performed directly into an area of scarring or at the site of a neoplastic lesion; exposure of an adequate duct for anastomosis is often difficult and may appear impossible. This paper describes an alternative approach to the hepatic ducts by dissection of the left hepatic ductal system. The method has been used with success in thirty-six patients.