Fascioperitoneal graft with T-tube drainage for patching bile duct defects

Abstract

Reconstruction of choledochal wall defects in an experimental dog model by T-tube plus fascioperitoneal graft and an evaluation of the short-term results were the aims of this study. Twelve randomly selected mongrel dogs of both sexes, having an average weight of 22.15 +/- 1.85 kg, were anaesthetized with ketamine HCI and xylazine and underwent laparatomy. The front wall of choledoch canal were excised with its all layers 0.5 cm in diameter at the distal part of the cystic duct junctions. These defects were repaired by using grafts prepared of the same diameter from the dorsal fascias of rectus muscles and peritoneum. T-tubes were introduced into the common ducts on the proximal part of the grafts. One of the animals died in the postoperative period due to evantration. T-tube cholangiograms on the twelfth day did not indicate any extravasation or stricture. Histopathological examination of the graft regions on the sixtieth day revealed that the epithelialization had commenced on the border between the bile epithelium and grafts. Based on these early findings, it was suggested that if supported by further studies it may be thought of as a clinical method.

Case Report: Surgical Correction of a Cystic Duct Stump Leakage Following Cholecystectomy Using an Autologous Rectus Sheath Graft in a Dog

“…ARS graft was highly successful with a 83-91% success rate in experimental dogs in several previous studies (16,24,26). Those clinical and experimental trials resulted in reconstructions of the biliary tract with no leakage, grossly similar appearance between the grafts and the bile duct, and biliary columnar epithelium covering the inner surface of the grafts (16,23,24,26). The same morphological change of ARS graft tissue was observed in a study that applied ARS graft for arterial replacement in a dog model (28).…”

“…ARS graft for the reconstruction of the bile duct in humans was first reported in 1917 (23). Several experimental applications of ARS graft in dogs were reported between 1998 and 2005 (16,24,26). ARS graft was highly successful with a 83-91% success rate in experimental dogs in several previous studies (16,24,26).…”

“…As an alternative option for CDSL closure, an autologous graft was used to cover the transected end of the cystic duct. That grafting for CDSL treatment is the most inventive part of this case report, because there are no other reports of such grafting attempted in a dog with CDSL, although there have been reports of the use of biomaterials or grafts to repair CBD injury by proximal and distal end-to-end anastomosis (16)(17)(18)(19)(20)(21)(22)(23)(24) or primary closure of choledochal wall defects (25,26). In order to attach the autologous graft to the CDS, the graft was sutured with simple interrupted 5-0 absorbable monofilament, similarly to previous reports in which interrupted 5-0 to 6-0 absorbable or non-absorbable suture was used to patch the graft to the CBD (16,17,19,22).…”

“…Several experimental applications of ARS graft in dogs were reported between 1998 and 2005 (16,24,26). ARS graft was highly successful with a 83-91% success rate in experimental dogs in several previous studies (16,24,26). Those clinical and experimental trials resulted in reconstructions of the biliary tract with no leakage, grossly similar appearance between the grafts and the bile duct, and biliary columnar epithelium covering the inner surface of the grafts (16,23,24,26).…”