Management of high bile duct carcinoma.

Based on experience with six patients with high bile duct carcinoma, a rational therapeutic approach is proposed. When extent of tumor precludes resection, the authors recommend palliation with a biliary-enteric anastomsis to avoid the complications and inconveniences of long-term transhepatic stenting. This is best accomplished with construction of a left cholangiojejunostomy using the round ligament approach. Temporary bilobar decompression may be necessary in select cases.