In 1948. Longmire and Sandford presented an ingenious and new approach to the problem of
extensive destruction of the hepathic ducts at the hilus of the liver. In 1956. Longmire and Lippman
reported 28 patients who had partial left hepatectomy and intrahepatic cholangiojejujnostomy per
formed by them and other surgeons. 19 of these precedures were done because of extensive
inflammatory obstruction of the hepatic duct at the hilus of the liver, and 9 were performed for
primary or secondary malignant obstruction of the common duct or common hepatic duct.
In 1958, Alvarez added a report of 2 cases of the carcinoma of the main hepatic ducts, within
the liver, treated by intrahepatic cholangiojejunostomy.
This reprot is included 25 cases of infiltrating carcinoma at the porta hepatis originated from
main hepatic duct, cystic duct, common bile duct, and Ampulla of Vater.
We performed intrahepatic cholangiojejunostomy in these cases and obtained the summary as
follows.
Summary
1. In the case of persistent jaundice due to inoperable malignant lesion of the biliary system at
the hilum of the liver, intra-hepatic cholangiojejunostomy is indicated.
Since the peripheral biliary tree is usually found about 1.0㎝ to the left or right of the falciform
ligament, it is a simpler and more convenient precedure to create the by-pass between the dilated
intra-hepatic biliary duct and the jejunum by the loop or Roux-en-Y type following wedge
resection measuring 3.0 by 3.0㎝, than to follow the Longmor´s precedure.
2. In 19 out of 25 cases the level of total serum bilirubin decreased and the general condition of
the patient was happy and comfortable for some following this procedure.
3. Even in the situation where the left and right intra-hepatic biliary ducts did not communicate
with each other because of being deeply involved in the malignant growth, when the precedure
of intra-hepatic cholangio-jejunostomy with either the left or the right intra-hepatic biliary duct
alone was preformed as an internal drainage, the alkaline phosphatase level did not decrease, but
the level of serum bilirubin fell and clinical jaundice was reduced.
4. This operative procedure is not indicated in cases having jaundice for over three months,
severe back pain, severe anorexia, or ascites.
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