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. 1982 Jun;136(6):484–504.

Obstructive Biliary Tract Disease

Thomas Taylor White 1
PMCID: PMC1273945  PMID: 7051569

Abstract

The techniques that have come into general use for diagnosing problems of obstructive jaundice, particularly in the past ten years, have been ultrasonography, computerized tomography, radionuclide imaging, transhepatic percutaneous cholangiography using a long thin needle, transhepatic percutaneous drainage for obstructive jaundice due to malignancy, endoscopic retrograde cannulation of the papilla (ERCP), endoscopic sphincterotomy and choledochoscopy. It is helpful to review obstructive jaundice due to gallstones from a clinical point of view and the use of the directable stone basket for the retrieval of retained stones, choledochoscopy for the same purpose using the rigid versus flexible choledochoscopes and dissolution of stones using various fluids through a T tube.

The use of dilation of the sphincter for the treatment of stenosis or stricture of the bile duct is now frowned on; rather, treatment choices are between the use of sphincteroplasty versus choledochoduodenostomy and choledochojejunostomy. Any patient with obstructive jaundice or anyone undergoing manipulation of the bile ducts should have prophylactic antibiotic therapy.

The current literature regarding treatment of cancer of the bile ducts is principally devoted to the new ideas relative to treatment of tumors of the upper third, especially the bifurcation tumors that are now being resected rather than bypassed. Tumors of the distal bile duct are still being resected by focal operations. Finally, it is now felt that early operation for congenital biliary atresia and choledochal cysts gives the best prognosis, with preoperative diagnosis now possible with the use of ultrasonography and ERCP.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akwari O. E., Kelly K. A. Surgical treatment of adenocarcinoma. Location: junction of the right, left, and common hepatic biliary ducts. Arch Surg. 1979 Jan;114(1):22–25. doi: 10.1001/archsurg.1979.01370250024004. [DOI] [PubMed] [Google Scholar]
  2. Aldrete J. S. Malignant neoplasms of the extrahepatic bile ducts. Am Surg. 1971 Oct;37(10):613–621. [PubMed] [Google Scholar]
  3. Allen B. L., Deveney C. W., Way L. W. Chemical dissolution of bile duct stones. World J Surg. 1978 Jul;2(4):429–437. doi: 10.1007/BF01563667. [DOI] [PubMed] [Google Scholar]
  4. Allen B., Shapiro H., Way L. W. Management of recurrent and residual common duct stones. Am J Surg. 1981 Jul;142(1):41–47. doi: 10.1016/s0002-9610(81)80009-8. [DOI] [PubMed] [Google Scholar]
  5. Andersson A., Bergdahl L., van der Linden W. Malignant tumors of the extrahepatic bile ducts. Surgery. 1977 Feb;81(2):198–202. [PubMed] [Google Scholar]
  6. Ashby B. S. Choledochoscopy. Clin Gastroenterol. 1978 Sep;7(3):685–700. [PubMed] [Google Scholar]
  7. Bauer J. J., Salky B. A., Gelernt I. M., Kreel I. Experience with the flexible fiberoptic choledochoscope. Ann Surg. 1981 Aug;194(2):161–166. doi: 10.1097/00000658-198108000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Behan M., Kazam E. Sonography of the common bile duct: value of the right anterior oblique view. AJR Am J Roentgenol. 1978 Apr;130(4):701–709. doi: 10.2214/ajr.130.4.701. [DOI] [PubMed] [Google Scholar]
  9. Bilbao M. K., Dotter C. T., Lee T. G., Katon R. M. Complications of endoscopic retrograde cholangiopancreatography (ERCP). A study of 10,000 cases. Gastroenterology. 1976 Mar;70(3):314–320. [PubMed] [Google Scholar]
  10. Bismuth H., Corlette M. B. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet. 1975 Feb;140(2):170–178. [PubMed] [Google Scholar]
  11. Black K., Hanna S. S., Langer B., Jirsch D. W., Rider W. D. Management of carcinoma of the extrahepatic bile ducts. Can J Surg. 1978 Nov;21(6):542–545. [PubMed] [Google Scholar]
  12. Burhenne H. J. Nonoperative instrument extraction of retained bile duct stones. World J Surg. 1978 Jul;2(4):439–445. doi: 10.1007/BF01563670. [DOI] [PubMed] [Google Scholar]
  13. CARTER R. F., SAYPOL G. M. Transabdominal cholangiography. J Am Med Assoc. 1952 Jan 26;148(4):253–255. doi: 10.1001/jama.1952.02930040009002. [DOI] [PubMed] [Google Scholar]
  14. Cameron J. L., Gayler B. W., Zuidema G. D. The use of silastic transhepatic stents in benign and malignant biliary strictures. Ann Surg. 1978 Oct;188(4):552–561. doi: 10.1097/00000658-197810000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Caroli J. Diseases of the intrahepatic biliary tree. Clin Gastroenterol. 1973 Jan;2(1):147–161. [PubMed] [Google Scholar]
  16. Chetlin S. H., Elliott D. W. Preoperative antibiotics in biliary surgery. Arch Surg. 1973 Aug;107(2):319–323. doi: 10.1001/archsurg.1973.01350200179037. [DOI] [PubMed] [Google Scholar]
  17. Classen M., Demling L. Endoskopische Sphinkterotomie der Papilla Vateri und Steinextraktion aus dem Ductus choledochus. Dtsch Med Wochenschr. 1974 Mar 15;99(11):496–497. doi: 10.1055/s-0028-1107790. [DOI] [PubMed] [Google Scholar]
  18. Cooperberg P. L., Li D., Wong P., Cohen M. M., Burhenne H. J. Accuracy of common hapatic duct size in the evaluation of extrahepatic biliary obstruction. Radiology. 1980 Apr;135(1):141–144. doi: 10.1148/radiology.135.1.7360952. [DOI] [PubMed] [Google Scholar]
  19. Cooperman M., Ferrara J. J., Carey L. C., Thomas F. B., Martin E. W., Jr, Fromkes J. J. Endoscopic retrograde cholangiopancreatography. Its use in the evaluation of nonjaundiced patients with the postcholecystectomy syndrome. Arch Surg. 1981 May;116(5):606–609. doi: 10.1001/archsurg.1981.01380170086015. [DOI] [PubMed] [Google Scholar]
  20. Corlette M. B., Jr, Bookwalter J. R. Individualization of treatment for hilar bile duct cancers. Cancer. 1980 Jul 15;46(2):415–419. doi: 10.1002/1097-0142(19800715)46:2<415::aid-cncr2820460235>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  21. Cotton P. B. ERCP. Gut. 1977 Apr;18(4):316–341. doi: 10.1136/gut.18.4.316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Danzi J. T., Makipour H., Farmer R. G. Primary sclerosing cholangitis. A report of nine cases and clinical review. Am J Gastroenterol. 1976 Feb;65(2):109–116. [PubMed] [Google Scholar]
  23. Davis J. L., Milligan F. D., Cameron J. L. Septic complications following endoscopic retrograde cholangiopancreatography. Surg Gynecol Obstet. 1975 Mar;140(3):365–367. [PubMed] [Google Scholar]
  24. Dayton M. T., Traverso L. W., Longmire W. P., Jr Efficacy of the gallbladder for drainage in biliary obstruction: a comparison of malignant and benign disease. Arch Surg. 1980 Sep;115(9):1086–1089. doi: 10.1001/archsurg.1980.01380090054013. [DOI] [PubMed] [Google Scholar]
  25. Deitch E. A. The reliability and clinical limitations of sonographic scanning of the biliary ducts. Ann Surg. 1981 Aug;194(2):167–170. doi: 10.1097/00000658-198108000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Dickson E. R., Fleming C. R., Ludwig J. Primary biliary cirrhosis. Prog Liver Dis. 1979;6:487–502. [PubMed] [Google Scholar]
  27. Douglass H. O., Jr Idiopathic sclerosing cholangitis. Pathophysiologic observations. Am J Surg. 1975 Jul;130(1):82–87. doi: 10.1016/0002-9610(75)90463-8. [DOI] [PubMed] [Google Scholar]
  28. Elias E., Hamlyn A. N., Jain S., Long R. G., Summerfield J. A., Dick R., Sherlock S. A randomized trial of percutaneous transhepatic cholangiography with the Chiba needle versus endoscopic retrograde cholangiography for bile duct visualization in jaundice. Gastroenterology. 1976 Sep;71(3):439–443. [PubMed] [Google Scholar]
  29. Fee H. J., Gewirtz H., Schiller J., Longmire W. P., Jr Sclerosing cholangitis and primary biliary cirrhosis--a disease spectrum? Ann Surg. 1977 Nov;186(5):589–593. doi: 10.1097/00000658-197711000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Ferrucci J. T., Jr Body ultrasonography (first of two parts). N Engl J Med. 1979 Mar 8;300(10):538–542. doi: 10.1056/NEJM197903083001006. [DOI] [PubMed] [Google Scholar]
  31. Ferrucci J. T., Jr, Mueller P. R., Harbin W. P. Percutaneous transhepatic biliary drainage: technique, results, and applications. Radiology. 1980 Apr;135(1):1–13. doi: 10.1148/radiology.135.1.7360943. [DOI] [PubMed] [Google Scholar]
  32. Filler R. M., Stringel G. Treatment of choledochal cyst by excision. J Pediatr Surg. 1980 Aug;15(4):437–442. doi: 10.1016/s0022-3468(80)80750-0. [DOI] [PubMed] [Google Scholar]
  33. Flanigan P. D. Biliary cysts. Ann Surg. 1975 Nov;182(5):635–643. doi: 10.1097/00000658-197511000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Fraumeni J. F., Jr Cancers of the pancreas and biliary tract: epidemiological considerations. Cancer Res. 1975 Nov;35(11 Pt 2):3437–3446. [PubMed] [Google Scholar]
  35. Glenn F., McSherry C. K. Congenital segmental cystic dilatation of the biliary ductal system. Ann Surg. 1973 Jun;177(6):705–713. doi: 10.1097/00000658-197306000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Go V. L., Taylor W. F., DiMagno E. P. Efforts at early diagnosis of pancreatic cancer: the Mayo Clinic Experience. Cancer. 1981 Mar 15;47(6 Suppl):1698–1705. doi: 10.1002/1097-0142(19810315)47:6+<1698::aid-cncr2820471439>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  37. Goldberg H. I., Filly R. A., Korobkin M., Moss A. A., Kressel H. Y., Callen P. W. Capability of CT body scanning and ultrasonography to demonstrate the status of the biliary ductal system in patients with jaundice. Radiology. 1978 Dec;129(3):731–737. doi: 10.1148/129.3.731. [DOI] [PubMed] [Google Scholar]
  38. Gregg J. A., McDonald D. G. Endoscopic retrograde cholangiopancreatography and gray-scale abdominal ultrasound in the diagnosis of jaundice. Am J Surg. 1979 May;137(5):611–615. doi: 10.1016/0002-9610(79)90033-3. [DOI] [PubMed] [Google Scholar]
  39. Hanna S. S., Rider W. D. Carcinoma of the gallbladder or extrahepatic bile ducts: the role of radiotherapy. Can Med Assoc J. 1978 Jan 7;118(1):59–61. [PMC free article] [PubMed] [Google Scholar]
  40. Hansson J. A., Hoevels J., Simert G., Tylén U., Vang J. Clinical aspects of nonsurgical percutaneous transhepatic bile drainage in obstructive lesions of the extrahepatic bile ducts. Ann Surg. 1979 Jan;189(1):58–61. doi: 10.1097/00000658-197901000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Hart M. J., White T. T. Central hepatic resection and anastomosis for stricture or carcinoma at the hepatic bifurcation. Ann Surg. 1980 Sep;192(3):299–305. doi: 10.1097/00000658-198009000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Heimbach D. M., White T. T. Immediate and long term effects of instrumental dilation of the sphincter of Oddi. Surg Gynecol Obstet. 1979 Jan;148(1):79–80. [PubMed] [Google Scholar]
  43. Hermann R. E. Editorial: A plea for a safer technique of cholecystectomy. Surgery. 1976 Jun;79(6):609–611. [PubMed] [Google Scholar]
  44. Hoevels J., Ihse I. Percutaneous transhepatic insertion of a permanent endoprosthesis in obstructive lesions of the extrahepatic bile ducts. Gastrointest Radiol. 1979 Nov 15;4(4):367–377. doi: 10.1007/BF01887559. [DOI] [PubMed] [Google Scholar]
  45. Hopton D., White T. T. An evaluation of manometric operative cholangiography in 100 patients with biliary disease. Surg Gynecol Obstet. 1971 Dec;133(6):949–954. [PubMed] [Google Scholar]
  46. Inouye A. A., Whelan T. J., Jr Carcinoma of the extrahepatic bile ducts: a ten year experience in Hawaii. Am J Surg. 1978 Jul;136(1):90–95. doi: 10.1016/0002-9610(78)90206-4. [DOI] [PubMed] [Google Scholar]
  47. Iwasaki Y., Ohto M., Todoroki T., Okamura T., Nishimura A. Treatment of carcinoma of the biliary system. Surg Gynecol Obstet. 1977 Feb;144(2):219–224. [PubMed] [Google Scholar]
  48. Jones S. A., Smith L. L. A reappraisal of sphincteroplasty (not sphincterotomy). Surgery. 1972 Apr;71(4):565–575. [PubMed] [Google Scholar]
  49. Juler G. L., Conroy R. M., Fuelleman R. W. Bile leakage following percutaneous transhepatic cholangiography with the Chiba needle. Arch Surg. 1977 Aug;112(8):954–958. doi: 10.1001/archsurg.1977.01370080052008. [DOI] [PubMed] [Google Scholar]
  50. KLATSKIN G. ADENOCARCINOMA OF THE HEPATIC DUCT AT ITS BIFURCATION WITHIN THE PORTA HEPATIS. AN UNUSUAL TUMOR WITH DISTINCTIVE CLINICAL AND PATHOLOGICAL FEATURES. Am J Med. 1965 Feb;38:241–256. doi: 10.1016/0002-9343(65)90178-6. [DOI] [PubMed] [Google Scholar]
  51. Kasai M., Asakura Y., Taira Y. Surgical treatment of choledochal cyst. Ann Surg. 1970 Nov;172(5):844–851. doi: 10.1097/00000658-197011000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Kasai M., Watanabe I., Ohi R. Follow-up studies of long term survivors after hepatic portoenterostomy for "noncorrectible" biliary atresia. J Pediatr Surg. 1975 Apr;10(2):173–182. doi: 10.1016/0022-3468(75)90275-4. [DOI] [PubMed] [Google Scholar]
  53. Kawai K., Akasaka Y., Murakami K., Tada M., Koli Y. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc. 1974 May;20(4):148–151. doi: 10.1016/s0016-5107(74)73914-1. [DOI] [PubMed] [Google Scholar]
  54. Keighley M. R., Baddeley R. M., Burdon D. W., Edwards J. A., Quoraishi A. H. A controlled trial of parenteral prophylactic gentamicin therapy in biliary surgery. Br J Surg. 1975 Apr;62(4):275–279. doi: 10.1002/bjs.1800620406. [DOI] [PubMed] [Google Scholar]
  55. Keighley M. R., Lister D. M., Jacobs S. I., Giles G. R. Hazards of surgical treatment due to microorganisms in the bile. Surgery. 1974 Apr;75(4):578–583. [PubMed] [Google Scholar]
  56. Kopelson G., Harisiadis L., Tretter P., Chang C. H. The role of radiation therapy in cancer of the extra-hepatic biliary system: an analysis of thirteen patients and a review of the literature of the effectiveness of surgery, chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys. 1977 Sep-Oct;2(9-10):883–894. doi: 10.1016/0360-3016(77)90186-9. [DOI] [PubMed] [Google Scholar]
  57. Landing B. H. Editorial: Changing approach to neonatal hepatitis and biliary atresia. Pediatrics. 1974 May;53(5):647–648. [PubMed] [Google Scholar]
  58. Lilly J. R. The Japanese operation for biliary atresia: remedy or mischief? Pediatrics. 1975 Jan;55(1):12–19. [PubMed] [Google Scholar]
  59. Lilly J. R. The surgical treatment of choledochal cyst. Surg Gynecol Obstet. 1979 Jul;149(1):36–42. [PubMed] [Google Scholar]
  60. Longmire W. P., Jr The diverse causes of biliary obstruction and their remedies. Curr Probl Surg. 1977 Jul;14(7):1–59. doi: 10.1016/s0011-3840(77)80003-8. [DOI] [PubMed] [Google Scholar]
  61. Mackie C. R., Cooper M. J., Lewis M. H., Moossa A. R. Non-operative differentiation between pancreatic cancer and chronic pancreatitis. Ann Surg. 1979 Apr;189(4):480–487. [PMC free article] [PubMed] [Google Scholar]
  62. Mazzariello R. M. A fourteen-year experience with nonoperative instrument extraction of retained bile duct stones. World J Surg. 1978 Jul;2(4):447–455. doi: 10.1007/BF01563671. [DOI] [PubMed] [Google Scholar]
  63. McCarthy J. D. Radiomanometric guides to common bile duct exploration. Am J Surg. 1977 Dec;134(6):697–701. doi: 10.1016/0002-9610(77)90305-1. [DOI] [PubMed] [Google Scholar]
  64. McClelland R. N. Controversy about the surgical treatment of choledochal cysts. Gastroenterology. 1978 Jun;74(6):1336–1337. [PubMed] [Google Scholar]
  65. McCune W. S., Shorb P. E., Moscovitz H. Endoscopic cannulation of the ampulla of vater: a preliminary report. Ann Surg. 1968 May;167(5):752–756. doi: 10.1097/00000658-196805000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. McDermott W. V., Peinert R. A. Carcinoma in the supra-ampullary portion of the bile ducts. Surg Gynecol Obstet. 1979 Nov;149(5):681–686. [PubMed] [Google Scholar]
  67. Miyata M., Satani M., Ueda T., Okamoto E. Long-term results of hepatic portoenterostomy for biliary atresia: special reference to postoperative portal hypertension. Surgery. 1974 Aug;76(2):234–237. [PubMed] [Google Scholar]
  68. Molnar W., Stockum A. E. Transhepatic dilatation of choledochoenterostomy strictures. Radiology. 1978 Oct;129(1):59–64. doi: 10.1148/129.1.59. [DOI] [PubMed] [Google Scholar]
  69. Moossa A. R., Levin B. The diagnosis of "early" pancreatic cancer: the University of Chicago experience. Cancer. 1981 Mar 15;47(6 Suppl):1688–1697. doi: 10.1002/1097-0142(19810315)47:6+<1688::aid-cncr2820471438>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  70. Morgan R. G., Wormsley K. G. Progress report. Cancer of the pancreas. Gut. 1977 Jul;18(7):580–596. doi: 10.1136/gut.18.7.580. [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. Moss J. P., Whelan J. G., Jr, Dedman T. C., 3rd, Voyles R. G. Postoperative choledochoscopy through the T-tube tract. Surg Gynecol Obstet. 1980 Dec;151(6):806–809. [PubMed] [Google Scholar]
  72. Nakayama T., Ikeda A., Okuda K. Percutaneous transhepatic drainage of the biliary tract: technique and results in 104 cases. Gastroenterology. 1978 Mar;74(3):554–559. [PubMed] [Google Scholar]
  73. Nora P. F., Berci G., Dorazio R. A., Kirshenbaum G., Shore J. M., Tompkins R. K., Wilson S. D. Operative choledochoscopy. Results of a prospective study in several institutions. Am J Surg. 1977 Jan;133(1):105–110. doi: 10.1016/0002-9610(77)90202-1. [DOI] [PubMed] [Google Scholar]
  74. Okabe N., Kawai K., Kondo O., Machida T., Adachi H., Watanuki T. Operative and postoperative choledochofiberoscopy. Am J Surg. 1979 Jun;137(6):816–820. doi: 10.1016/0002-9610(79)90103-x. [DOI] [PubMed] [Google Scholar]
  75. Okuda K., Tanikawa K., Emura T., Kuratomi S., Jinnouchi S. Nonsurgical, percutaneous transhepatic cholangiography--diagnostic significance in medical problems of the liver. Am J Dig Dis. 1974 Jan;19(1):21–36. doi: 10.1007/BF01073350. [DOI] [PubMed] [Google Scholar]
  76. Pereiras R. V., Jr, Rheingold O. J., Huston D., Mejia J., Viamonte M., Chiprut R. O., Schiff E. R. Relief of malignant obstructive jaundice by percutaneous insertion of a permanent prosthesis in the biliary tree. Ann Intern Med. 1978 Nov;89(5 Pt 1):589–583. doi: 10.7326/0003-4819-89-5-589. [DOI] [PubMed] [Google Scholar]
  77. Pilepich M. V., Lambert P. M. Radiotherapy of carcinomas of the extrahepatic biliary system. Radiology. 1978 Jun;127(3):767–770. doi: 10.1148/127.3.767. [DOI] [PubMed] [Google Scholar]
  78. Polk H. C., Jr, Lopez-Mayor J. F. Postoperative wound infection: a prospective study of determinant factors and prevention. Surgery. 1969 Jul;66(1):97–103. [PubMed] [Google Scholar]
  79. Pollock T. W., Ring E. R., Oleaga J. A., Freiman D. B., Mullen J. L., Rosato E. F. Percutaneous decompression of benign and malignant biliary obstruction. Arch Surg. 1979 Feb;114(2):148–151. doi: 10.1001/archsurg.1979.01370260038005. [DOI] [PubMed] [Google Scholar]
  80. Praderi R. C. Twelve years' experience with transhepatic intubation. Ann Surg. 1974 Jun;179(6):937–940. doi: 10.1097/00000658-197406000-00021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  81. Rattner D. W., Warshaw A. L. Impact of choledochoscopy on the management of choledocholithiasis. Experience with 499 common duct explorations at the Massachusetts General Hospital. Ann Surg. 1981 Jul;194(1):76–79. doi: 10.1097/00000658-198107000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  82. Reiter J. J., Bayer H. P., Mennicken C., Manegold B. C. Results of endoscopic papillotomy: a collective experience from nine endoscopic centers in West Germany. World J Surg. 1978 Jul;2(4):505–511. doi: 10.1007/BF01563686. [DOI] [PubMed] [Google Scholar]
  83. Ring E. J., Oleaga J. A., Freiman D. B., Husted J. W., Lunderquist A. Therapeutic applications of catheter cholangiography. Radiology. 1978 Aug;128(2):333–338. doi: 10.1148/128.2.333. [DOI] [PubMed] [Google Scholar]
  84. SHORE J., LIPPMAN H. N. A FLEXIBLE CHOLEDOCHOSCOPE. Lancet. 1965 Jun 5;1(7397):1200–1201. [PubMed] [Google Scholar]
  85. SMITH R. HEPATICOJEJUNOSTOMY WITH TRANSHEPATIC INTUBATION: A TECHNIQUE FOR VERY HIGH STRICTURES OF THE HEPATIC DUCTS. Br J Surg. 1964 Mar;51:186–194. doi: 10.1002/bjs.1800510307. [DOI] [PubMed] [Google Scholar]
  86. Safrany L. Transduodenal endoscopic sphincterotomy and extraction of bile duct stones. World J Surg. 1978 Jul;2(4):457–464. doi: 10.1007/BF01563673. [DOI] [PubMed] [Google Scholar]
  87. Sample W. F., Sartl D. A., Goldstein L. I., Weiner M., Kadell B. M. Gray-scale ultrasonography of the jaundiced patient. Radiology. 1978 Sep;128(3):719–725. doi: 10.1148/128.3.719. [DOI] [PubMed] [Google Scholar]
  88. Saypol G. M., Kurian G. A technique of repair of stricture of the bile duct. Surg Gynecol Obstet. 1969 May;128(5):1071–1076. [PubMed] [Google Scholar]
  89. Schein C. J., Beneventano T. C. Biliary manometry: its role in clinical surgery. Surgery. 1970 Feb;67(2):255–260. [PubMed] [Google Scholar]
  90. Schein C. J. Influence of choledochoscopy on the choice of surgical procedure. Am J Surg. 1975 Jul;130(1):74–77. doi: 10.1016/0002-9610(75)90461-4. [DOI] [PubMed] [Google Scholar]
  91. Schwartz S. I. Primary sclerosing cholangitis: a disease revisited. Surg Clin North Am. 1973 Oct;53(5):1161–1167. doi: 10.1016/s0039-6109(16)40144-1. [DOI] [PubMed] [Google Scholar]
  92. Siegel J. H. Endoscopic management of choledocholithiasis and papillary stenosis. Surg Gynecol Obstet. 1979 May;148(5):747–752. [PubMed] [Google Scholar]
  93. Silvis S. E., Rohrmann C. A., Vennes J. A. Diagnostic accuracy of endoscopic retrograde cholangiopancreatography in hepatic, biliary, and pancreatic malignancy. Ann Intern Med. 1976 Apr;84(4):438–440. doi: 10.7326/0003-4819-84-4-438. [DOI] [PubMed] [Google Scholar]
  94. Smallwood R. A., Williams H. A., Rosenoer V. M., Sherlock S. Liver-copper levels in liver disease: studies using neutron activation analysis. Lancet. 1968 Dec 21;2(7582):1310–1313. doi: 10.1016/s0140-6736(68)91814-x. [DOI] [PubMed] [Google Scholar]
  95. Stone H. H., Hooper C. A., Kolb L. D., Geheber C. E., Dawkins E. J. Antibiotic prophylaxis in gastric, biliary and colonic surgery. Ann Surg. 1976 Oct;184(4):443–452. doi: 10.1097/00000658-197610000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  96. Stuart M., Hoerr S. O. Late results of side to side choledochoduodenostomy and of transduodenal sphincterotomy for benign disorders. A twenty year comparative study. Am J Surg. 1972 Jan;123(1):67–72. doi: 10.1016/0002-9610(72)90313-3. [DOI] [PubMed] [Google Scholar]
  97. Suarez C. A., Block F., Bernstein D., Serafini A., Rodman G., Jr, Zeppa R. The role of H.I.D.A./P.I.P.I.D.A. scanning in diagnosing cystic duct obstruction. Ann Surg. 1980 Apr;191(4):391–396. doi: 10.1097/00000658-198004000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  98. Szlabick R. E., Catto J. A., Fink-Bennett D., Ventura V. Hepatobiliary scanning in the diagnosis of acute cholecystitis. Arch Surg. 1980 Apr;115(4):540–544. doi: 10.1001/archsurg.1980.01380040162029. [DOI] [PubMed] [Google Scholar]
  99. THORBJARNARSON B. Carcinoma of the bile ducts. Cancer. 1959 Jul-Aug;12(4):708–713. doi: 10.1002/1097-0142(195907/08)12:4<708::aid-cncr2820120413>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  100. Terblanche J. Is carcinoma of the main hepatic duct junction an indication for liver transplantation or palliative surgery? A plea for the U tube palliative procedure. Surgery. 1976 Feb;79(02):127–128. [PubMed] [Google Scholar]
  101. Thomas C. G., Jr, Nicholson C. P., Owen J. Effectiveness of choledochoduodenostomy and transduodenal sphincterotomy in the treatment of benign obstruction of the common duct. Ann Surg. 1971 Jun;173(6):845–856. doi: 10.1097/00000658-197106010-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  102. Tompkins R. K., Thomas D., Wile A., Longmire W. P., Jr Prognostic factors in bile duct carcinoma: analysis of 96 cases. Ann Surg. 1981 Oct;194(4):447–457. doi: 10.1097/00000658-198110000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  103. Tsuzuki T., Uekusa M. Carcinoma of the proximal bile ducts. Surg Gynecol Obstet. 1978 Jun;146(6):933–943. [PubMed] [Google Scholar]
  104. Ulreich S., Foster K. W., Stier S. A., Rosenfield A. T. Acute cholecystitis. Comparison of ultrasound and intravenous cholangiography. Arch Surg. 1980 Feb;115(2):158–160. doi: 10.1001/archsurg.1980.01380020026006. [DOI] [PubMed] [Google Scholar]
  105. Warren K. W., Athanassiades S., Monge J. I. Primary sclerosing cholangitis. A study of forty-two cases. Am J Surg. 1966 Jan;111(1):23–38. doi: 10.1016/0002-9610(66)90339-4. [DOI] [PubMed] [Google Scholar]
  106. Warren K. W., Mountain J. C., Lloyd-Jones W. Malignant tumours of the bile-ducts. Br J Surg. 1972 Jul;59(7):501–505. doi: 10.1002/bjs.1800590702. [DOI] [PubMed] [Google Scholar]
  107. Watts D. R., Lorenzo G. A., Beal J. M. Proceedings: Congenital dilatation of the intrahepatic biliary ducts. Arch Surg. 1974 Apr;108(4):592–598. doi: 10.1001/archsurg.1974.01350280192032. [DOI] [PubMed] [Google Scholar]
  108. Weissmann H. S., Frank M. S., Bernstein L. H., Freeman L. M. Rapid and accurate diagnosis of acute cholecystitis with 99mTc-HIDA cholescintigraphy. AJR Am J Roentgenol. 1979 Apr;132(4):523–528. doi: 10.2214/ajr.132.4.523. [DOI] [PubMed] [Google Scholar]
  109. Weissmann H. S., Frank M., Rosenblatt R., Goldman M., Freeman L. M. Cholescintigraphy, ultrasonography and computerized tomography in the evaluation of biliary tract disorders. Semin Nucl Med. 1979 Jan;9(1):22–35. doi: 10.1016/s0001-2998(79)80005-7. [DOI] [PubMed] [Google Scholar]
  110. Whelton M. J., Petrelli M., George P., Young W. B., Sherlock S. Carcinoma at the junction of the main hepatic ducts. Q J Med. 1969 Apr;38(150):211–230. [PubMed] [Google Scholar]
  111. Whipple A. O., Parsons W. B., Mullins C. R. TREATMENT OF CARCINOMA OF THE AMPULLA OF VATER. Ann Surg. 1935 Oct;102(4):763–779. doi: 10.1097/00000658-193510000-00023. [DOI] [PMC free article] [PubMed] [Google Scholar]
  112. White T. T., Bordley J., 4th One per cent incidence of recurrent gallstones six to eight years after manometric cholangiography. Ann Surg. 1978 Oct;188(4):562–569. doi: 10.1097/00000658-197810000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  113. White T. T. Indications for sphincteroplasty as opposed to choledochoduodenostomy. Am J Surg. 1973 Aug;126(2):165–170. doi: 10.1016/s0002-9610(73)80148-5. [DOI] [PubMed] [Google Scholar]
  114. White T. T. Indications for sphincteroplasty as opposed to choledochoduodenostomy. Am J Surg. 1973 Aug;126(2):165–170. doi: 10.1016/s0002-9610(73)80148-5. [DOI] [PubMed] [Google Scholar]
  115. Wiesner R. H., LaRusso N. F. Clinicopathologic features of the syndrome of primary sclerosing cholangitis. Gastroenterology. 1980 Aug;79(2):200–206. [PubMed] [Google Scholar]

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