A novel treatment for bile duct injury with a tissue-engineered bioabsorbable polymer patch

Aikawa, Masayasu; Miyazawa, Mitsuo; Okamoto, Kojyun; Toshimitsu, Yasuko; Torii, Tetsuya; Okada, Katsuya; Akimoto, Naoe; Ohtani, Yoshihide; Koyama, Isamu; Ikada, Yoshito

doi:10.1016/j.surg.2009.10.049

Cited by 40 publications

(41 citation statements)

References 20 publications

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“…The repair of biliary tree lesions with these scaffolds has already been partially demonstrated by several studies, particularly by Japanese authors. A group from Saitama Medical University proposed the use of a copolymer of PLA and PCL reinforced with fibers of polyglycolic acid [24]. The results at 6 months are encouraging, because total resorption of the material used and formation of a tissue completely uniform to the native anatomic structures of the animal were noted.…”

Section: Discussionmentioning

confidence: 99%

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Electrospun Polyhydroxyethyl-Aspartamide–Polylactic Acid Scaffold for Biliary Duct Repair: A Preliminary In Vivo Evaluation

Buscemi

Damiano

Fazzotta

et al. 2017

Transplantation Proceedings

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Tissue engineering has emerged as a new approach with the potential to overcome the limitations of traditional therapies. The objective of this study was to test whether our polymeric scaffold is able to resist the corrosive action of bile and to support a cell's infiltration and neoangiogenesis with the aim of using it as a biodegradable tissue substitute for serious bile duct injuries. In particular, a resorbable electrospun polyhydroxyethylaspartamideepolylactic acid (90 mol% PHEA, 10 mol% PLA)/polycaprolactone (50:50 w/w) plate scaffold was implanted into rabbit gallbladder to assess the in vivo effects of the lytic action of the bile on the scaffold structure and then as a tubular scaffold to create a biliarydigestive anastomosis as well. For the above evaluation, 5 animals were used and killed after 15 days and 5 animals after 3 months. At 15-day and 3-month follow-ups, the fibrillar structure was not digested by lytic action bile. The fibers of the scaffold were organized despite being in contact with bile action. A new epithelial tissue appeared on the scaffold surface suggesting the suitability of this scaffold for future studies of the repair of biliary tract injuries with the use of resorbable copolymer on biliary injuries. E XTRAHEPATIC biliary tract lesions occurring during laparoscopic cholecystectomy are burdened by perioperative morbidity and mortality [1,2], reduction of longterm survival [3], and reduction of the patient's quality of life [4,5]. Although the incidence of biliary injury during laparotomy is 0.1%e0.2% [6], in the case of the laparoscopic approach it becomes w2-fold or even 3-fold higher [7].Various attempts have been made to reconstruct the bile duct with the use of nonabsorbable vascular grafts, such as expanded polytetrafluoroethylene, with unsatisfactory results due to a high rate of stenosis, early-occurring infections, and long-term foreign body reactions [8e12]. Autologous grafts have been proposed as possible prosthetic material, but they showed extremely low results in the long term [13e16].Rosen et al [17] described a method of biliary tree regeneration using the porcine small intestinal submucosa, another alternate material that does not involve any foreign body reaction but is burdened by the risk of zoonoses and abnormal wound healing [18,19].At present the criterion-standard surgical option is the creation of derivative biliary-digestive anastomoses: nevertheless, this kind of intervention does not restore a complete physiologic anatomy and is burdened by a high rate of morbidity and mortality with a consequent reduction in the patient's quality of life. The approach of regenerative medicine could be the most simple and effective solution for the repair of iatrogenic lesions of the biliary tract [20e23]. The tissue engineering approach requires the use of biodegradable scaffolds to allow cell recruitment from the Funding: PRIN 2015: "Chirurgia rigenerativa nei difetti della parete addominale e nel deficit congenito o acquisito delle vie escretrici urinarie, b...

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Section: Discussionmentioning

confidence: 99%

“…* boundary tissues, their proliferation stimulating new capillary formation in the first post-implantation phase and allowing the deposition of new extracellular matrix thanks to its progressive reabsorption [24]. Some polymeric materials have already been proposed as artificial substitutes of both natural and synthetic bile ducts [25,26].…”

mentioning

confidence: 99%

Electrospun Polyhydroxyethyl-Aspartamide–Polylactic Acid Scaffold for Biliary Duct Repair: A Preliminary In Vivo Evaluation

Buscemi

Damiano

Fazzotta

et al. 2017

Transplantation Proceedings

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“…Multiple experimental trials have been reported replacing the biliary defects with a variety of materials but failed to support the usefulness of these materials. [22][23][24][25][26][27] Our new procedure utilizing IVGT interposition has the advantage of being physiologic keeping normal path of bile and keeping the sphincter of Oddi's function thus maintaining a normal anatomy without reflux. Even when performing anastomosis with the duodenum reflux is not pronounced as the size of stoma is small (<10 mm) and the stoma is designed projecting into the lateral wall of the middle of the second part of duodenum to be amenable for ERCP examination if required.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic bile duct injury repair using isolated vascularized gastric tube: early experience in two tertiary centers

Helmy

Ali

2017

Int Surg J

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INTRODUCTIONAbout 80% of BDI occur after cholecystectomy constituting a catastrophe for both the patient and the surgeon as they are associated with significant morbidity and mortality, reducing long-term survival and quality of life, and are associated with high rates of subsequent litigation.1,2 Laparoscopic cholecystectomy (LC) has largely replaced open cholecystectomy (OC) but its potential disadvantage is a 2-fold increase in BDI. Moreover, injuries after LC are more proximal, are revealed earlier, are presented by leaks more than by strictures, are repaired more frequently by nonspecialists, and more associated with lost segment and ischemia due to combined vascular injury.3 Most of BDI present as biliary stricture, external or internal fistula, and biliary peritonitis. 4 If left untreated BDI may be complicated with biliary strictures, hepatic atrophy, cholangitis and intra-hepatic lithiasis. Later, fibrosis or even secondary biliary cirrhosis and portal hypertension can develop, enhanced by prolonged biliary obstruction associated with recurrent cholangitis.5 Also there is ABSTRACT Background: Bile duct injuries (BDI) constitute a disaster for both the patient and the surgeon without satisfactory results with the classic use of roux-en-Y hepaticojejunostomy (RYHJ). The purpose of this study was to evaluate our newly introduced technique utilizing isolated vascularized gastric tube (IVGT) as an alternative for RYHJ in reconstruction of the bile duct after iatrogenic BDI with lost segment. Methods: This is a prospective study included 18 consecutive patients suffered from iatrogenic BDI with lost segment admitted to Assiut and Sohag University Hospitals, during the period from September 2013 to June 2016. Patients were subjected to operative treatment with the interposition of IVGT to bridge the lost bile duct segment. Patients were evaluated regarding demographic criteria, clinical picture, different investigations, efficacy of the use of IVGT and evaluation of post-operative complications after a mean follow-up of 2 years. Results: Eighteen patients underwent repair of BDI utilizing IVGT during the study period. Three patients (17%) suffered immediate repairs, 10 patients (55%) experienced intermediate repairs and late repairs were performed for the last 5 patients (28%). Bile leak as a specific early morbidity was present in 3 patients (17%) with upper biliary tract injury without any operative mortality. Also, there was one patient with stent obstruction relieved by stent extraction. With long-term follow-up there was not any patient of biliary stricture. Conclusions: IVGT proved to be feasible and safe for bile duct replacement and is a good alternative for biliary reconstruction being more anatomical and physiological than RYHJ.

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“…[8][9][10] These studies suggest that the best material for duct repair is autologous tissue resistant to bile, so we chose the tubular gastric wall in the present study.…”

Section: Discussionmentioning

confidence: 99%

A Promising Method for Repairing Low-Level Biliary Strictures After Cholecystectomy

Cheng

Huang

Dong

2015

International Surgery

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The purpose of this study is to introduce and evaluate a new technique of repairing bile ducts by the tubular gastric wall with a vascularized pedicle. Both the end-to-end bile duct repair and Roux-en-Y hepatoenterostomy have limitations in the treatment of benign bile duct strictures after cholecystectomy. There are no other good choices to manage these cases, especially the bile duct transection injuries or partly missing common bile duct or hepatic duct. Eleven patients with partly missing common bile ducts in the Chinese People's Liberation Army General Hospital between January 2007 and December 2012 were retrospectively analyzed. The study comprised 8 females and 3 males, whose age ranged from 29 to 56 years. All patients underwent successful bile duct repair. The time of operations ranged from 210 minutes to 240 minutes. The maximal blood loss was less than 220 ml. There was no perioperative mortality and no case of gastric fistula. Postoperative complications occurred in 3 patients, including wound infection, bile leakage, and erosive gastritis. All complications were cured by conservative treatment. The mean follow-up time was 42 months. One patient was classified as Terblanche's grade II and 10 patients were classified as Terblanche's grade I. The observations indicate that this technique is a feasible and effective choice to manage low level biliary stricture after cholecystectomy, especially suitable to repair bile duct transection injuries or partly missing common bile duct or hepatic duct.

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A novel treatment for bile duct injury with a tissue-engineered bioabsorbable polymer patch

Cited by 40 publications

References 20 publications

Electrospun Polyhydroxyethyl-Aspartamide–Polylactic Acid Scaffold for Biliary Duct Repair: A Preliminary In Vivo Evaluation

Electrospun Polyhydroxyethyl-Aspartamide–Polylactic Acid Scaffold for Biliary Duct Repair: A Preliminary In Vivo Evaluation

Iatrogenic bile duct injury repair using isolated vascularized gastric tube: early experience in two tertiary centers

A Promising Method for Repairing Low-Level Biliary Strictures After Cholecystectomy

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