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October 1994

Invited Commentary

Author Affiliations

Baltimore, Md

Arch Surg. 1994;129(10):1062. doi:10.1001/archsurg.1994.01420340076013

This article on the surgical management of sclerosing cholangitis adds additional data to the controversy concerning management of this disease. All are in agreement that when primary sclerosing cholangitis has progressed to the point where biliary cirrhosis is present, the only surgical option is liver transplantation. Myburgh's experience with five patients with cirrhosis treated by biliary bypass reinforces this position. However, his series of 16 noncirrhotic patients and our similar series of 26 patients1-3 treated by excision of the extrahepatic biliary tree, including the bifurcation, demonstrate that some patients with advanced primary sclerosing cholangitis who have developed persistent jaundice but who do not have cirrhosis can be treated successfully on a long-term basis without liver transplantation. As Myburgh points out, we demonstrated in 1984 that the dominant stricture in sclerosing cholangitis is often at or near the hepatic duct bifurcation.2 Resecting and/or bypassing the hepatic duct bifurcation along

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