Limited resection and hepaticoduodenostomy for Bismuth type II hilar cholangiocarcinoma in a frail diabetic patient: a feasible oncologic alternative

A 71-year-old diabetic man presented with progressive cholestatic jaundice secondary to a Bismuth II hilar cholangiocarcinoma. Surgical exploration revealed a tumor confined to the biliary confluence. A limited en bloc resection of the confluence with multiple biliary reconstructions by end-to-side hepaticoduodenostomy was performed without hepatic resection. The postoperative course was uneventful. This case illustrates the feasibility of limited hilar resection with direct biliary reconstruction in selected frail patients when extended hepatectomy is contraindicated.