Bile Duct Resection Alone

This operation is rarely indicated nowadays and only when the primary tumour is located exactly in the middle of the common hepatic duct with no invasion or spread, without portal or arterial involvement. It is also an option for high-risk patients who cannot tolerate hepatic resection due to the presence of cirrhosis or severe co-morbidities. It is considered a minimally invasive, less radical surgical treatment. After completion of lymph node dissection of hepatic pedicle and division of distal bile duct at the supraduodenal level, right and left Glisson pedicles are more exteriorized thanks to posterior access at the hilum that allows en-bloc resection of Glisson sheath and intrahepatic biliary ducts. Particular attention must be paid to dissect biliary confluence from portal vascular plane and right hepatic artery that runs behind biliary bifurcation. Whenever the right and left hepatic ducts are exposed, they are divided upon positioning a stay suture. The section of the left duct is usually farther from bifurcation as the left duct is longer than the right. On the right, given the shortness of the duct, the section line is on the bifurcation of anterior and posterior ducts. On the posterior aspect of the biliary confluence several biliary ducts are found that arise from the caudate lobe and can be either tied or anastomosed to the digestive tract (Fig. 2).

Fig. 2a,b Isolated resection of bile duct. a The common bile duct is turned cranially to expose the bile ducts branches of right posterior and caudate lobe. b Surgical field at the end of resection with bile ducts of the left and right side. Numbers refers to Couinaud's segments. PV, Portal vein; CBD, common bile duct; RHA, right hepatic artery; LHA, left hepatic artery

Fig. 2a,b Isolated resection of bile duct. a The common bile duct is turned cranially to expose the bile ducts branches of right posterior and caudate lobe. b Surgical field at the end of resection with bile ducts of the left and right side. Numbers refers to Couinaud's segments. PV, Portal vein; CBD, common bile duct; RHA, right hepatic artery; LHA, left hepatic artery

Restoration of digestive continuity is realised with a 50-60 cm Roux-en-Y jejunal loop anastomosed to right and left biliary ducts with interrupted or continuous PDS® 5/0 stitches.

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Baby Sleeping

Baby Sleeping

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