Histological and bacteriological evaluations for antireflux function of intussusceptive valve in reconstructed biliary tract

Abstract

Objective To evaluate the antireflux function of intussusceptive valve in Roux-en-Y cholangiojejunostomy reconstructed biliary tract through bacteriohistological methods in biliary intestinal limb. Methods A total of 20 adult rabbits were equally randomized into experimental and control groups. After common bile duct ligation, biliary reconstruction in experimental group was performed by Roux-en-Y cholecystojejunostomy with an intussusceptive valve in biliary intestinal limb while control group underwent Roux-en-Y cholecystojejunostomy alone. Both groups were bred for 3 months after surgery. Then bile bacterial culture and histological study of biliary loop were performed. The data were analyzed with t test for comparing between two groups and self-control. Results Bile colony counts in cholecystojejunostomy and jejunojejunostomy anastomosis were (2.67±0.39) 104/ml and (3.92±1.25) 104/ml in experimental group versus (3.84±0.68) 104/ml and (4.06±0.73) 104/ml in control group respectively. The count in cholecystojejunostomy anastomosis was less in experimental group than that in control (P=0.041). However, there was no significant inter-group difference in count for jejunojejunostomy anastomosis (P=-1.342). And the colony count at proximal end was less than that at distal end of biliary loop as compared within experimental group (P=0.032). However, no significant difference existed in data with control group in corresponding positions (P=0.952). The shape of intussusceptive valve in biliary loop was anatomically intact and there were fibrosis and a mild infiltration of inflammatory cells. There were different degrees of inflammatory reaction in loop tissue. And the infiltration of inflammatory cells was more pronounced in control group and distal end in both groups than that in proximal end of experimental group. Conclusions The intussusceptive valve on reconstructed biliary tract may prevent the refluxant cholangitis effectively through reducing bacteria reproduction and alleviating inflammatory reaction in proximal end of bile loop after Roux-en-Y hepaticojejunostomy. Key words: Anastomosis, roux-en-Y; Histology; Bacteriology