Reconstructive operations on the biliary tract.

Fifty cases in which reconstruction of the biliary system was carried out were reviewed. In 25 cases the operation was done during the treatment of malignant neoplasms. The other 25 patients were treated for benign conditions. Delayed stricture of the biliary anastomosis occurs more frequently following operation for benign post-traumatic obstruction than following reconstruction for other conditions. This is probably a result of: (1) greater regional scarring, (2) local infection, and (3) technical imperfections in the reconstituted biliary anastomosis. Certain primary malignant tumors may be difficult to recognize by both gross and microscopic examination. In six cases of biliary obstruction resulting from malignant neoplasms in the present series, exploration had been carried out some time previously, and in four of them an erroneous diagnosis of benign biliary obstruction was made.End-to-end anastomosis of the duct above and below the point of obstruction is the method preferred in the treatment of benign biliary stricture. Intrahepatic and extrahepatic biliary-enteric anastomoses have been used successfully in selected cases.