Abstract The diagnosis and surgical treatment of carcinoma of the common hepatic duct present difficult problems. Accurate preoperative localization of the obstructive lesion is essential and slim needle transhepatic percutaneous cholangiography is the investigation of choice. Worth while palliation may be achieved if biliary-enteric flow can be re-established by introducing a plastic stenton through the obstructive lesion in the bile duct. Three patients are reviewed who survive 36, 31 and 26 months after this operation. A further patient died of metastases after 5 months.