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.
Highlights
Biliary injuries as a result of cholecystectomy and other biliary operations are complex and serious
Regarding iatrogenic biliary strictures, Roux-en-Y hepaticojejunostomy is the standard procedure of choice [4]
The cause of septic peritonitis was obscure minor iatrogenic bowel perforation which had sealed spontaneously later on was suspected
Summary
Biliary injuries as a result of cholecystectomy and other biliary operations are complex and serious. Other significantly less common indications for hepaticojejunostomy include biliary fibrosis produced by chronic pancreatitis, penetrating trauma of the porta hepatis, previous bilioenteric operation with subsequent stricture formation, choledochal cyst resections and other causes of iatrogenic biliary trauma such as gastric, pancreatic or hepatic resections, portal decompression procedures and liver transplantation. Malignant conditions such as cholangiocarcinoma and gall bladder carcinoma infiltrating CBD or hepatic ducts may indicate hepaticojejunostomy as a final step of the resective procedure or as a palliative attempt to relieve jaundice in instances of unresectability [5]. Our aim was to evaluate a new method for biliary reconstruction using an isolated pedicled gastric tube in a live animal trial and to present the first clinical case
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