[The topographic-anatomical starting point in reconstructive surgery on the choledochus].

Operative tactics in reconstructive surgery of the common bile duct depend on localization of the lesions or strictures and special topography of this region. At first, it must be decided whether a direct suture seems to be practicable or a biliodigestive anastomosis has to be constructed. There is a better chance to succeed in performing an end-to-end anastomosis the farther away the occlusion is situated from the liver hilus. The main advantage of this procedure can be seen in the restoration of physiological bile discharge. Frequently, however, it shows a tendency to shrink even years later. Often--for establishing a choledochocholedochostomy without tension--it is an important fact that the terminal common bile duct can be partially removed from the pancreas and thereby lengthened for 1--2 cm at the most. From this point of view, the topographic details particularly concerning reconstructive surgery of the common bile duct are described, based on post mortem studies of 48 human cadavers.