PMC3082482_01
Imaging at MRCP (left) and ERCP (right).
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F1
Dissection of the cystic stump.
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F3
The first step was to recognize and dissect the cystic stump (fig. 3). Then we mobilized and retracted inferiorly the hepatic flexure of the colon to provide exposure of the duodenal sweep.
Common bile duct circumferentially mobilized and isolated.
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F4
Superiorly the dissection proceeded until the common bile duct narrowed, at which point the common bile duct was circumferentially mobilized (fig. 4).
Presence of before unrecognized anatomical variation of the right biliary tree.
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F5
Before transecting the cyst below the hepatic duct bifurcation, we observed a before unrecognized anatomical variation of the right biliary tree (fig. 5), so we performed an intraoperative cholangiography that confirmed the presence of an aberrant posterior hepatic duct (VI-VII segment) (fig. 6).
Each hepatic duct was separately anastomosed to the jejunal limb.
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F7
Each hepatic duct (fig. 7) was then separately anastomosed to the jejunal limb over a temporary silicon stent, such as a pediatric feeding tube.
Intraoperative final result.
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F8
Figure 8 shows the intraoperative final result.