To evaluate the application value of portojejunal anastomosis (Kasai procedure) in radical resection of hilar cholangiocarcinoma.

Clinical data of 8 patients with hilar cholangiocarcinoma treated in the Affiliated Hospital of Inner Mongolia Medical University from December, 2011 to December, 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 5 patients were male and 3 female, aged from 45 to 69 years, with a median age of 58 years. According to Bismuth-Corlette classification, 1 casewas classified as Bismuth-Corlette type Ⅱ, 2 cases of type Ⅲa, 1 case of type Ⅲb and 4 cases of type Ⅳ.All patients underwent radical resection of hilar cholangiocarcinoma, and biliary reconstruction was performed by using Kasai procedure. Surgical conditions and postoperative complications were observed.

All 8 patients successfully underwent surgery. No perioperative death occurred. R0 resection rate was 6/8. The average operation time was (245±37) min, intraoperative blood loss was (350±100) ml, postoperative time to first flatus was (2.5±0.7) d, and the length of postoperative hospital stay was (18±9) d, respectively. Postoperative complications occurred in 2 cases, including 1 case of bile leakage who was cured after conservative treatment, such as adequate drainage and anti-infection. 1 case with pulmonary infection recovered after anti-inflammatory treatment. During postoperative follow-up from 3 weeks to 24 months,1 patient developed reflux esophagitis at postoperative 6 months, and relevant symptoms were relieved after conservative treatment. 1 patient died of multiple organ failure at 12 months after operation, 1 patient died of abdominal metastasis of tumor at postoperative 12 months, and 2 patients died of extensive intrahepatic metastases from postoperative 16 to 24 months, respectively.

Kasai procedure can extend the indications for radical resection of hilar cholangiocarcinoma, elevate the radical resection rate and success rate of biliary reconstruction and reduce the incidence of postoperative bile leakage. It is a simple, convenient and safe procedure, especially for patients with multiple hepatic duct openings, small internal diameter, distant hepatic duct openings or even shrinkage in the liver.