Published online Apr 21, 2013. doi: 10.3748/WJG.v19.i15.2441
Revised: March 1, 2013
Accepted: March 15, 2013
Published online: April 21, 2013
At present, radical resection remains the only effective treatment for patients with hilar cholangiocarcinoma. The surgical approach for R0 resection of hilar cholangiocarcinoma is complex and diverse, but for the biliary reconstruction after resection, almost all surgeons use Roux-en-Y hepaticojejunostomy. A viable alternative to Roux-en-Y reconstruction after radical resection of hilar cholangiocarcinoma has not yet been proposed. We report a case of performing duct-to-duct biliary reconstruction after radical resection of Bismuth IIIa hilar cholangiocarcinoma. End-to-end anastomosis between the left hepatic duct and the distal common bile duct was used for the biliary reconstruction, and a single-layer continuous suture was performed along the bile duct using 5-0 prolene. The patient was discharged favorably without biliary fistula 2 wk later. Evidence for tumor recurrence was not found after an 18 mo follow-up. Performing bile duct end-to-end anastomosis in hilar cholangiocarcinoma can simplify the complex digestive tract reconstruction process.
Core tip: Roux-en-Y anastomosis is the standard of care for biliary reconstruction after radical resection of hilar cholangiocarcinoma. However, a direct duct-to-duct biliary reconstruction preserves the normal sphincter mechanism and endoscopic access to the biliary tree for diagnostic and therapeutic purposes. Duct-to-duct biliary reconstruction is widely used in liver transplantation and hepatic resection. The objective of this study was to determine the feasibility of duct-to-duct biliary reconstruction in the setting of Bismuth IIIa hilar cholangiocarcinoma with limited biliary confluence involvement.