Biliary Reconstruction for Intrahepatic Bile Duct Strictures and Optimal Jejunal Limb Length in Congenital Biliary Dilation Surgery: A Literature Review and Consensus Statements From the AOB Consensus Meeting

INTRODUCTION: With the aim of facilitating cross-specialty discussion on detailed anatomical interpretations in congenital biliary dilatation surgery, the Japan Society for Endoscopic Surgery (JSES) and the Consensus Meeting of Anatomy on the Border (AOB) developed a series of consensus statements in 2024. This report focuses specifically on biliary reconstruction for intrahepatic bile duct strictures and the optimal jejunal limb length. METHODS: These statements were based on a comprehensive literature review and a nationwide questionnaire survey. RESULTS: For intrahepatic bile duct strictures, the need to tailor surgical approaches according to the location and underlying cause of the stricture has been recognized. When a stricture was located in the hilar or proximal intrahepatic bile ducts and direct surgical intervention was feasible, procedures such as stricture repair, membranous resection, or septal excision were commonly performed. In contrast, when the stricture was located more peripherally and direct intervention was difficult, alternative strategies, such as hepatectomy, endoscopic bile duct reconstruction, or additional hepaticojejunostomy to the upstream bile duct, were employed. For the optimal length of the jejunal limb, it is recommended that the jejunal limb length be adjusted according to body size in children under 5 years of age, and that the natural length be applied in children 5 years of age and older, as well as in adults. CONCLUSION: The current evidence remains insufficient and further research is warranted to establish more definitive conclusions. This statement was finalized with the agreement of all expert panel members.