title: Biliary reconstruction when the liver hilum is inaccessible: the anterior approach.
abstract: OBJECTIVE
  This paper focuses on a novel approach to biliary reconstruction after previous extensive liver surgery.
  
  
  BACKGROUND
  Bile leak and subsequent biliary strictures are not uncommon after extensive liver surgery. Biliary reconstruction is then required, but the liver hilum is usually inaccessible for further surgical intervention.
  
  
  METHODS
  A novel surgical technique is described in two patients with biliary stenosis after previous extensive liver surgery. Access to the biliary tree was obtained using an anterior approach. A previously inserted PTC drain was used as guidance to the bile duct suitable for creating a biliary-digestive anastomosis.
  
  
  RESULTS
  The described technique proved to cause complete biliary drainage in both patients. There was no treatment-related morbidity nor was further biliary intervention needed during follow-up.
authors.affiliation: University Hospital Aintree, Department of General and Hepatobiliary Surgery, Longmoor Lane, Liverpool L9 7AL, United Kingdom. d.grunhagen@erasmusmc.nl
authors.forename: D J
authors.initials: DJ
authors.lastname: Grünhagen
authors.forename: S W
authors.initials: SW
authors.lastname: Fenwick
authors.forename: G J
authors.initials: GJ
authors.lastname: Poston
authors.forename: H Z
authors.initials: HZ
authors.lastname: Malik
mesh_terms: D000328:Adult; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000601:surgery*; D002758:Cholangiography; D004322:Drainage; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007582:Jejunostomy; D008099:Liver / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged