Novel technique for biliary reconstruction using an isolated gastric tube with a vascularized pedicle: a live animal experimental study and the first clinical case

Abstract

BackgroundBiliary tract reconstruction continues to be a challenging surgical problem. Multiple experimental attempts have been reported to reconstruct biliary defects with different materials and variable outcome. Our aim was to evaluate a new method for biliary reconstruction using an isolated pedicled gastric tube in a live animal trial and also to present the first clinical case.MethodsSeven mongrel dogs underwent biliary reconstruction using gastric tube harvested, completely separated from the greater curvature, and based on a vascularized pedicle with the right gastroepiploic vessels. The tube was interposed between the common bile duct (CBD) and the duodenum. Postoperative mortality, morbidity, liver functions, gross and microscopic histological picture were assessed. The first clinical case was also presented where, in a patient with post-cholecystectomy biliary injury, an isolated pedicled gastric tube was interposed between the proximal and distal ends of the CBD.ResultsOne dog did not recover from anesthesia and another one died postoperatively from septic peritonitis. Five dogs survived the procedure and showed uneventful course and no cholestasis. The mean anastomotic circumference was 4.8 mm (range 4-6) for CBD anastomosis and 6.2 mm (range 5-7) for duodenal anastomosis. Histologically, anastomotic sites showed good evidence of healing. In the first clinical case, the patient showed clinical and biochemical improvement. Endoscopic retrograde cholangiography was feasible and assured patent biliary anastomoses.ConclusionIn mongrel dogs, biliary reconstruction using pedicled gastric tube interposition between CBD and duodenum is feasible with satisfactory clinical results, anastomotic circumference and histological evidence of healing. The technique is also feasible in human and seems to be promising.

Effect of tamoxifen on fibrosis, collagen content and transforming growth factor‐β1, ‐β2 and ‐β3 expression in common bile duct anastomosis of pigs

“…; Helmy et al . ). If bile duct injury is detected during surgery, end‐to‐end anastomosis could be considered a sufficient treatment (de Reuver et al .…”

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

“…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).…”

Repair of a common bile duct defect with a decellularized ureteral graft

“…Until recently, there were no satisfactory reliable substitutes with which to replace common bile duct defects and restore function in clinical practice. Only a few case reports have been published on repairs of the common bile duct defects using autografts[23-25]. …”