Median hepatotomy using ultrasonic dissection for complex hepatobiliary problems.

Strictures of the Intrahepatic ducts, centrally located hepatic tumors, and intrahepatic stones present difficult management problems. The median hepatotomy can be easily and safely performed with the aid of an ultrasonic liver dissector and a knowledge of hepatic anatomy. The approach allows the confluence of the right and left hepatic ducts and primary and secondary bifurcations thereof to be exposed precisely without dissecting the porta or compromising the blood supply to the liver. We employed this technique without mortality and with minimal morbidity in eight patients, of whom two had Klatskin's tumors, one had an iatrogenic stricture of the right hepatic duct, one had sclerosing cholangitis, one had Intrahepatic gallstones, and three had centrally located tumors. The technique is recommended as an aid in the management of complex hepatobiliary problems.