Fig. 4.

Principles of division of the left hepatic duct and reconstruction as a single hepaticojejunostomy. Division of the left hepatic duct in a macroscopically tumor-free portion, just before (a) or beyond (b,c) the segmental ramification, resulting in one (a), two (b), or three (c) orifices draining segments 2 (‡), 3 (+), and 4 (#). Reconstruction of the left bile duct (d) or after partial reunification of the ducts draining segments 2, 3 and 4 (e,f) as a single hepaticojejunostomy, as needed. Intraluminal decompression and splinting using a transhepatic NEUHAUS drainage not shown for didactical reasons