Novel reconstruction of the extrahepatic biliary tree with a biosynthetic absorbable graft

Abstract

ObjectivesThe reference standard technique for the reconstruction of the extrahepatic biliary tree is Roux-en-Y hepaticojejunostomy. This procedure is not without complications and may not be feasible in some patients. This project sought to evaluate a novel approach for repairing common bile duct injuries with a biosynthetic graft. This allows for the reconstruction of the anatomy without necessitating an intestinal bypass. MethodsStudy subjects were 11 mongrel hounds. Utilizing an open approach, the common bile duct was transected in each animal. A 1-cm graft of a synthetic bioabsorbable prosthesis was interposed over a 5-Fr pancreatic stent and sewn in place as an interposition tube graft with absorbable sutures. Intraoperative cholangiograms and monthly liver function tests were completed. Animals were killed at 6, 7, 8, 10 and 12 months. ResultsThe first five animals were killed early in the process of protocol development. One animal developed obstructive symptoms and was killed on postoperative day 14. The next five animals were longterm survivors without evidence of clinically significant graft stenosis. Mean alkaline phosphatase and total bilirubin were normal, at 140U/l and 0.2mg/dl, respectively. Histology showed the complete replacement of the graft with native tissue at 6 months. ConclusionsBiliary reconstruction using a synthetic bioabsorbable prosthetic as an interposition tube graft is feasible based on initial results.Biliary reconstruction using a synthetic bioabsorbable prosthetic is possible