Anatomical Resection of the Bile Duct: A Hidden Door to the Bile Duct.

BACKGROUND/AIMS: Pancreas-preserving resection of the bile duct has been attempted as an organ preserving procedures for the treatment of low-grade malignant neoplasms of the bile duct. The fact that the lower bile duct penetrates pancreas head to join the duodenum, makes those attempts one of the challenging procedures in biliary tract surgery. Here we present a novel and unique surgical technique for anatomically resecting lower bile duct, focusing on the anatomy of the pancreas head.

METHODOLOGY: A patient with middle bile duct cancer underwent this procedure. Subsequent to Kocher's maneuver, pancreas head was dissected from the posterior side of the duodenum that was a key step to recognize the embryological fusion plane between the anterior and the posterior pancreatic segments. Along this fusion plane pancreas head was able to be divided and the covering pancreatic parenchyma was split open to expose the whole intrapancreatic bile duct.

RESULTS: The patient had no signs of pancreatic fistula and post-operative course was uneventful. Negative surgical margins were obtained thanks to the presented technique.

CONCLUSIONS: This procedure might be applicable for the treatment of bile duct neoplasms, in case of lesions spread to the lower bile duct. Otherwise that might require pancreatoduodenectomy.