Surgical treatment for iatrogenic damage at the confluence of hepatic duct

Since 1989, 4 patients with iatrogenic bile duct injuries at the level of bifurcation were treated. Among them, the bifurcation together with both right and left hepatic duct had had wrongly been resected in 2 cases. The bifurcation was partially resected in the other 2 cases. The establishment of a permanent hepaticoentertostomy is essential. Abnormal bile flow would impede surgical effect, hence in the author's opinion, peripheral hepaticoenterostomy such as Longmire's procedure is unsuitable for iatrogenic bile duct injuries. The author's special technique for adequate exposure and accurate dissection of intrahepatic bile ducts is described. Four cases have been followed up for 7 months to 5 years with good result.