Abstract
Analyze the morphological and structural outcomes of a patch of expanded polytetrafluoroethylene in the treatment of an iatrogenic injury of the common bile duct. In Group 1 (Sham), 7 dogs underwent 3 laparotomies with intervals of 30 days between them. In Group 2, 10 dogs underwent transient common bile duct obstruction. After 30 days, this biliary occlusion was undone and a patch of expanded polytetrafluoroethylene replaced a fragment removed from the duct's wall. Thirty days after this last surgery, cholangiographic assessment of prosthesis patency and macro and microscopic evaluation of the biliary tract were performed. Daily clinical inspection completed the study outcomes. The Wilcoxon non-parametric test was used for statistical analysis. In all dogs enlargement of the biliary tree diameter was observed 30 and 60 days after the first surgical procedure. Partial adhesion of the patch to the common bile duct as a free luminal foreign body was found in 6 dogs. The prosthesis was completely integrated to surrounding tissue in the remaining four. Although a feasible option for the treatment of biliary duct iatrogenic lesions, the expanded polytetrafluoroethylene prosthesis must be used with caution considering the potential risks for complications.
Highlights
The major cause of benign biliary lesions is surgical trauma
Bile duct injury brings about serious complications, and the outcome of the reparative surgery depends on the gravity of the injury intraoperative conditions and the technique chosen[1,2,3,4]
Synthetic grafts or prostheses developed in the last century, including Vitallium, rubber, Daflon, Silastic, expanded polytetrafluoroethylene, have been tested to improve the prognosis of surgical correction of iatrogenic lesions of the biliary tree[17,18,19,20,21,22,23,24,25]
Summary
The major cause of benign biliary lesions is surgical trauma. Laparoscopic biliary procedures, interventional endoscopic approaches and orthotopic liver transplantation surgeries have increased the number of reports of benign biliary strictures.Bile duct injury brings about serious complications, and the outcome of the reparative surgery depends on the gravity of the injury intraoperative conditions and the technique chosen[1,2,3,4].Usually the diagnosis of extrahepatic biliary duct injury is delayed until clinical signs of obstruction have appeared. The major cause of benign biliary lesions is surgical trauma. By far, the most common surgical procedure[5,6]. Biological tissues, such as veins, arteries, small bowel, omentum, gallbladder, fascial and muscular sheaths, skin, muscles and pericardium and other tissues have been utilized without reliable results[7,8,9,10,11,12,13,14,15,16]. The variety of suggested techniques and materials shows that the results for the treatment of biliary duct damage are still unsatisfactory[26]. Growing evidence has supported the ePTFE tube, a Teflon-coated graft, in the management of common bile duct injury controversies about its use still remain
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