The closed system Silastic sump drains are removed after 5 or 6 days unless there is a significant bile output or a leak is shown on cholangiography. If no leaks are found from the superior surface of the liver or the anastomosis, three-way stopcocks are attached to the end of the catheters. The patients are trained to self-administer injections of sterile saline into the stents three times per day. Consultation with radiation medicine and medical oncology is recommended to guide the next steps in therapy. This should be done prior to removal of the stents as these may be used to guide placement of radioactive seeds. External radiotherapy of 5,000 to 6,000 rads may be given as an outpatient procedure. Following this, patients may be readmitted for 48 hours while iridium 192 seeds are drawn into the transhepatic biliary system, and 2,000 additional rads are given by this means. Irrigations are continued by the patient three times per day. The old stents are replaced every three or four months and new ones are introduced under fluoroscopic surveillance by placing guide wires down through the old stent. The old stent is removed and used as a template for the number and position of the holes. The new stent is easily placed in proper position, and the guide wire is removed. Bile cultures are taken from time to time, and appropriate antibiotics may be required. Duodenal obstruction rarely occurs after radiation therapy. The long-term salvage rate is relatively low, but a significant increase in average length of survival, coupled with an increased quality of life, justifies this major procedure.