Liver, Gallbladder, Biliary Tract, and Pancreas


Before the liver is removed, the hepatoduodenal ligament should be dissected. In children over 2 yr the hepatobilliary ducts can usually be dissected without difficulty. First, the common bile duct is incised and opened toward the hilus and the ampulla of Vater. The lowermost portion of the common bile duct runs retroduodenally. The duodenum must be pulled in the anterior direction and somewhat to the left if the full length of the common bile duct is to be exposed without cutting into the wall of the duodenum. Prior formalin fixation facilitates the dissection. In fetuses and newborns, dissection of the common bile duct may be difficult, and its patency is easier to check by opening the duodenum and observing whether bile can be milked out through the ampulla. This is a useful test, particularly when biliary atresia is suspected.


Bile Duct Common Bile Duct Biliary Atresia Choledochal Cyst Hepatoduodenal Ligament 
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