Abstract STRICTURES of the bile ducts remain a serious surgical problem. Despite the numerous reconstructive procedures that have been tried,1 many patients eventually succumb with recurrence of the stricture, repeated attacks of cholangiohepatitis and progressive damage to the liver. End to end suture of the divided ends of the bile ducts, if performed without undue tension, has given the best results. Unfortunately this procedure is not always possible, particularly when long segments of the ducts have been destroyed or when the defect extends into the hilus of the liver. By mobilizing the duodenum and, when necessary, splitting the head of the pancreas for identification of the distal duct, Lahey2 and Cattell3 have extended the scope of primary anastomosis of the duct ends. When this method is not feasible, one must choose between preserving the sphincter of Oddi by bridging the defect and by-passing the sphincter of Oddi by References 1. Horgan, E.: Reconstruction of the Biliary Tract: A Review of All the Methods That Have Been Employed , New York, The Macmillan Company, 1932. 2. Lahey, F. H.: Further Experiences with Injured Bile Ducts , New England J. Med. 240:161, 1949.Crossref 3. Cattell, R. B.: Benign Strictures of the Biliary Ducts , J. A. M. A. 134:235 ( (May 17) ) 1947.Crossref 4. (a) Cole, W. H.; Reynolds, J. T., and Ireneus, C., Jr.: Strictures of the Common Duct , Ann. Surg. 128:332, 1948.Crossref 5. (b) Lahey.2 6. Fitts, W. T., Jr.; Cooper, D. Y., and Lazatin, C.: The Role of the Sphincter of Oddi in the Prevention of Cholangitis: Data Presented in the Forum on Fundamental Surgical Problems, American College of Surgeons, Los Angeles, Oct. 22, 1948. 7. Allen, A. W.: Method of Re-Establishing Continuity Between Bile Ducts and Gastro-Intestinal Tract , Tr. South. S. A. 56:28, 1945. 8. Walters, W.: Stricture of the Bile Ducts , in Christopher's Textbook of Surgery , Philadelphia, W. B. Saunders Company, 1949.
Archives of Surgery – American Medical Association
Published: Sep 1, 1950