A technique for intrahepatic reconstruction of the biliary tree after complex high injuries is described. The fundament of the procedure is the removal of a wedge of segment IV at the level of the hilar plate. When the hilar plate is reached and no adequate exposure of the ducts can be obtained, removing a 1×1-in wedge of segment IV between the gallbladder bed and the round ligament exposes the left and right ducts. An anteroposterior view of the plate is obtained instead of a caudocephalic dissection, exposing healthy, nonscarred ducts for reconstruction. We have used this approach in 22 patients, and adequate exposure of the ducts has been obtained, with a high success rate of patency of the anastomosis at a mean follow-up of 3 years. Twenty patients have a patent anastomosis, with a good quality of life and no restenosis.
Mercado MA, Orozco H, de la Garza L, López-Martínez LM, Contreras A, Guillén-Navarro E. Biliary Duct InjuryPartial Segment IV Resection for Intrahepatic Reconstruction of Biliary Lesions. Arch Surg. 1999;134(9):1008–1010. doi:10.1001/archsurg.134.9.1008