Vellar (2001) reported: "The venous drainage at the bifurcation of the common hepatic duct
has been shown to enter the segment I and segment IV directly.
The jejunum was lifted and was anastomosed with the hepatic duct
using 5-0 absorbable thread.
The main hepatic duct
that is required to dissect right above the cystic duct, was dissected after the fusion (Figure 1), and continuity was provided with hepaticojejunostomy.
The mouth of the hepatic duct
to be anastomosed was prepared taking into account the principle that the injured hepatic duct
mucosa should reach the proximal end, where it is sufficiently vascularized.
The procedures included common hepatic duct
exploration, stone clearance by fiber-optic choledochoscopy, hilar bile duct hepaticoplasty with preservation of the sphincter of Oddi, anastomosis between the hilar bile duct and neck of the gallbladder, and establishment of a subcutaneous tunnel with the gallbladder.
Bismuth-Corlette perihilar cholangiocarcinoma classification system (1) Type I Involves common hepatic duct
only Type II Involves confluence of the primary hepatic ducts
Type IIIa Extends from the bifurcation up the right hepatic duct
Type IIIb Extends from the bifurcation up the left hepatic duct
Type IV Extends bilaterally from the bifurcation of the common hepatic duct
or multifocal involvement Table 3: Contraindications to curative surgery (1) Medical Contraindications A.
Type 4: Right hepatic duct
drains into the cystic duct.
There are a wide variety of endoscopic techniques to achieve hemostasis; the choice of which to implement will depend on the cause (e.g., trauma), location (e.g., common hepatic duct
), and source (e.g., paracholedochal vein) of hemobilia, for instance, postsphincterotomy hemobilia, which typically is a result of injury to the posterior branch of the superior pancreaticoduodenal artery (itself a branch of the gastroduodenal artery) during sphincterotomy.
After dividing the common hepatic duct
, two openings were appreciated indicating that the division of common hepatic duct
occurred at the confluence.
After that, the common bile duct was ligated into two parts: a distal ligature was placed just before the entrance to the pancreas, and a proximal ligature was placed below the hepatic duct
junction, both with 7-0 polypropylene.
MRI/MRCP was thus performed, which was significant for an abrupt change in caliber at the biliary anastomosis consistent with stricture (ABS), dilatation of the common hepatic duct
(CHD) to 7 mm, and a curvilinear filling defect at the level of the anastomosis (Figure 2).
The mass was obstructing the proximal common hepatic duct
resulting in dilatation of the intrahepatic biliary tree (Figure 1).