Reconstruction Of Common Bile Duct Research Articles

Application of cholecystic duct plasty in the prevention of biliary complications following orthotopic liver transplantation.

The purpose was aimed to evaluate the safety and effectiveness of cholecystic duct plasty (CDP) and biliary reconstruction techniques preventing biliary complications following orthotopic liver transplantation (OLT) first proposed by our center. 127 enrolled patients who underwent LT in our center from January 2015 to December 2019 were analyzed retrospectively. According to the mode of biliary tract reconstruction, patients were divided into CDP group (Group 1, n = 53) and control group (Group 2, n = 74). The differences of perioperative general data, biliary complications and long-term prognosis between two groups were compared and analyzed. All patients completed the operation successfully, the incidence of perioperative complications was 22.8%. There was no significant difference in perioperative general data and complications between the two groups. Follow-up ended in June 2020, with a median follow-up period of 31 months. During the follow-up period, biliary complications occurred in 26 patients, with an overall incidence of 20.5%. The overall incidence of biliary complications and anastomotic stenosis in Group 1 was lower than that in Group 2 (P < 0.05). There was no significant difference in overall prognosis between the two groups (P = 0.274), however, the cumulative incidence of biliary complications in Group 1 was lower than that in Group 2 (P = 0.035). Reconstruction of common bile duct by CDP represents considerable safety and practicability, particularly for patients with small diameter of common bile duct or wide discrepancy of bile duct size between donor and recipient.

Early versus delayed reconstruction for bile duct injury a multicenter retrospective analysis of a hepatopancreaticobiliary group

Common bile duct injury is a severe complication. It is related to increased rates of morbidity and mortality. Early recognition and on-time diagnosis plus multidisciplinary management of this disease led by a hepatobiliary surgeon show fewer complications rate and best postoperative outcomes. However, no guidelines exist about the proper time of reconstruction. This study aims to describe the experience of a specialized Hepato-Pancreatic-Biliary (HPB) group and to analyze the outcomes regarding the time of bile duct injury (BDI) repair. A multicenter retrospective review of a prospective database was conducted. All the patients older than 18 years old that underwent common bile duct reconstruction between January 2014 and December 2021 were included. Analysis and description of preoperative characteristics and postoperative outcomes were performed. A reconstruction time-based group differentiation was made and analyzed. 44 patients underwent common bile duct reconstruction between January 2014 and December 2021. 56.82% of the patients were female. The mean age was 53.27 years ± 20.7 years. The most common injury was type E2 (29.55%). Hepaticojejunostomy was performed in 81.81% (of the patients. Delayed reconstruction (> 72 h) was performed in the majority of the cases (75.00%) due to delays in the referral centers or poor condition. No statistically significant difference regarding complications in early or delayed BDI reconstruction. The mortality rate was 2.7% (n = 1). 2-year follow-up bilioenteric stenosis was observed in 7 patients. Biloma showed a statistical relationship with complex bile duct injuries (p = 0.02). Bile duct injury is a severe and complex postoperative complication that increases morbidity and mortality rates in the short and long term in patients undergoing cholecystectomy. In our study, there were no statistical differences between the timing of bile duct reconstruction and the postoperative outcomes; we identified the presence of biloma as a statistically related factor associated with complex bile duct injury; however, further prospective or studies with an increased sample size are required to prove our results.

Biodegradation of poly( l-lactide- co-glycolide) tube stents in bile

The objective of this study was to evaluate degradation behavior and the feasibility of biodegradable polymeric stents in common bile duct (CBD) repair and reconstruction. Various molar ratios of lactide (LA) and glycolide (GA) in poly( l-lactide- co-glycolide) (PLGA) were synthesized and processed into a circular tubing of ∼10.0 mm outer diameter and a wall thickness of about 2.0 mm. This tubing was cut into 40.0 mm length to form CBD stents. The stents were placed into human bile to determine the degradation behavior in vitro. The morphology, configuration, mass loss, water uptake, molecular weight and composition changes were examined. The PLGA with LA/GA = 71/29 exhibited an acceptable degradation life and was chosen as an in vivo stent material. These PLGA stents were used in common bile duct exploration (CBDE) and primary suturing for rats. Degradation status of the stents was examined and comparison was made between those before and after surgical procedure. The results showed that the polymer stents exhibited the same biomedical functions as T tubes and spontaneously disappeared from CBD in 4–5 weeks. Therefore, the PLGA stents fits the requirements in repair and reconstruction of CBD, to support the duct, guide bile drainage and reduce T-tube-related complications.

Vascularized venous autografts in common bile duct reconstruction.

THE SURGICAL correction of benign stricture of the common bile duct is one of the most technically challenging surgical problems. As emphasized by Cattell1and others, the best long-term results ensue when the ampulla of Vater's normal function is preserved. In the clinical setting, however, this is frequently not possible. The only recourse then is to implant the proximal duct into an adjacent portion of jejunum or duodenum. Considerable effort has been expended in the search for a suitable substitute for biliary ductal structures. Imaginative attempts using metal, rubber, and plastics2-5have uniformly been unsuccessful. Viable structures of all sorts have been tried. These have included autogenous vein, artery, appendix, fascia, peritoneum, jejunum, and skin,6-10as well as homografts of preserved common bile duct and artery.10None of these tissues so used has met with success in a significant percentage of cases. Failures in graft substitution

Excision of a choledochal cyst. Common bile duct reconstruction with a gastric pedicle tube.

In a 31-year-old woman a congenital choledochal cyst that replaced the entire common bile duct was completely excised and the duct replaced by a gastric pedicle tube constructed from the greater curvature of the stomach and nourished by the right gastroepiploic vessels. The patient is completely well, 18 months after the operation. This gastric pedicle tube operation, done for the first time on a patient with a benign obstruction of the bile ducts, has the following advantages: (1) The greater curvature of the stomach is readily accessible and the duodenum need not be mobilized; (2) the gastric pedicle tube can be made any reasonable length and diameter by virtue of its excellent blood supply from the gastroepiploic vessels; and (3) bile passes through the duodenum, whereas in a choledochojejunostomy the duodenum is by-passed and peptic ulceration can result.

Reconstruction of Common Bile-Duct

Reconstruction of Common Bile-Duct