Derivation of the intrahepatic biliary tree through the hepatic parenchyma is the only option in patients with numerous stenosis of the biliary confluence and the primary hepatic ducts.

Two cases are included in the Video, in the first one the intrahepatic biliary tree is dissected through the greater elongated opening and in the second one the intrahepatic biliary duct of the right and left lobe is completely opened, shaped like a "T". In the derivation an "Y-Roux" loop is used of about 65 centimeters of lenght.

This procedure is in general unknown, requiring a great knowledge of the hepatic architecture.