Biliary reconstruction when the liver hilum is inaccessible: the anterior approach

OBJECTIVE: This paper focuses on a novel approach to biliary reconstruction after previous extensive liver surgery.

SUMMARY BACKGROUND DATA: Bile leak and subsequent biliary strictures are not uncommon after extensive liver surgery. Biliary reconstruction is then required, but the liver hilum is usually inaccessible for further surgical intervention.

METHODS: A novel surgical technique is described in two patients with biliary stenosis after previous extensive liver surgery. Access to the biliary tree was obtained using an anterior approach. A previously inserted PTC drain was used as guidance to the bile duct suitable for creating a biliary-digestive anastomosis.

RESULTS: The described technique proved to cause complete biliary drainage in both patients. There was no treatment-related morbidity nor was further biliary intervention needed during follow-up.