Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver.

It is important to expand the indications for resection of tumors of the hilas, generally requiring associated hepatectomy, after careful search for metastases and biopsy of any suspicious areas makes this reasonable. One can justify such a procedure, representing a major stress and a considerable mortality rate, only if one is sure that all the tumor will be removed. If resection cannot be carried out, a unilateral intrahepatic cholangioenteric anastomosis with preference for the round ligament technique is an excellent procedure when properly applied. If a contraindication to a left sided anastomosis exists, particularly invasion of the left sided confluences, the anastomosis is made on the right to the duct of segment V. Study of the cholangiogram with attenion to the primary and secondary confluences directs a decision to perform a double anastomosis the ducts are not dilated or a poor quality anastomosis is all that can be achieved on one side and when secondary confluents are involved on both sides. The results of a variety of techniques emphasize the importance of the cholangiogram in choosing the location of an anastomosis and the role of invasion of primary and secondary conversions in choosing the technique. Many of thse patients are young and, even if no resection is possible, amy survive several years. A renewed sense of well being and prolongation of life are achievable goals even if the tumor cannot be removed. There is every reason to offer the maximum to these patients so that, if they muse eventually die, it will be from the tumor itself and not from its biliary complications.