Modification of the Longmire Procedure

Two modifications of the Longmire procedure of intrahepatic cholangiojejunostomy are reported. The first involves the preoperative placement under fluoroscopic control of a large Teflon catheter in the distal left hepatic duct to facilitate the identification and isolation of the duct at the time of surgery. The second modification is the use of a transhepatic silastic biliary stent positioned by utilizing the Teflon catheter. These modifications make the Longmire procedure technically much easier, and should help insure long-term success in both benign and malignant strictures. A successful case utilizing these modifications is reported.