After the back row has been placed and the sutures secured, an enterotomy is made with the electrocautery (8). The posterior row of sutures is divided, and both stents are placed into the Roux-en-Y loop through the single enterotomy. The knots of the posterior layer are on the inside, but since the suture material is absorbable, this is of no consequence. The anterior row of the anastomosis is completed with a single interrupted layer of through and through sutures of 4-0 synthet­ic absorbable material (9). All such sutures are placed and then secured. Both Silastic transhepatic biliary stents are brought out through stab wounds in the right and left upper quadrants, and sutured to the skin with 5-0 stainless steel wire, and connected to gravity bile-bag drainage. Both egress sites on the superior surface of the liver are drained with closed-suc­tion Silastic drains, brought out through separate stab wounds in the right and left upper quadrants. The anastomosis is drained with a third closed-suction Silastic drain brought out through a stab wound in the mid-abdomen. The Roux-en-Y loop may be sutured to the undersurface of the liver with interrupted 3-0 silks. With a 60 cm Roux-en-Y loop, howev­er, it generally rests comfortably in the right upper quadrant, and this may not be necessary. The Roux-en-Y loop is sutured to the rent in the transverse mesocolon with interrupted 4-0 silks (10).