A pedunculate patch, obtained from a disconnected segment of jejunum, was implanted into the longitudinal incision of the ductus choledochus. Intra-operatively, the findings were based upon direct cholecystocholangiography; postoperatively, upon laboratory tests. After an observation period of 12 months a new cholangiography of the transplant was made along with a selective picture of the mesenteric arteries. The choledochus duct with the transplant was examined histologically. Three dogs died immediately postoperatively of peritonitis due to suture insufficiency. Five dogs died of invaginate ileus. These animals, as well as the remaining 8 dogs showed macroscopically and microscopically a smooth and uneventful healing of the transplant at the end of the observation period. Radiographies showed free flow of the biliary duct system. The selective mesenteric arteriographies evidenced beginning anastomosis between the transplant and the capillaries of the bile duct. Based on the results presented, the pedunculate jejunal graft can be considered well suited as an expansion graft for the bile duct.
Simple end-to-end reconstruction of benign bile duct stenosis is possible only in a few cases. To preserve the function of papilla of Vater as the best anticholangitis therapy, we developed a method of bile duct expansion by a pedunculated jejunal patch-graft in animal experiments. After these successful experiments three patients with iatrogenic short bile duct stenosis were treated with this operation. These patients remain free of pathologic clinical and radiological findings 8-30 months after surgery.
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