Microsurgery of the common bile duct

Summary Although most surgeons continue to adhere to the use of direct intraductal drainage routinely after choledochotomy for a variety of reasons including fear of biliary peritonitis, we believe that this may not always be in the patients' best interest. The practice of primary closure of the common bile duct is preferred in selected cases by a number of well qualified surgeons in the present and past centuries. As a matter of fact, drainage of the common bile duct may hinder rather than help the recovery of patients. The use of a binocular surgical microscope, especially a surgical diploscope with 400 to 500 mm focal distance lenses, allows the surgeons to accurately approximate common bile duct incisions or transections without the use of stents or drainage. A nonbile leakage closure of primary type can be obtained because of excellent lighting and magnification of the surgical field and the use of fine suture material.