Proposal of a new technique for bile duct reconstruction after iatrogenic injury: study in dogs and review of the literature

Abstract

Purpose: Interposition of a jejunal tube between the common bile duct and duodenum. Methods: Five adult mongrel dogs of both sexes, weighing on average 22.3 kg (18 to 26.5 kg), were used. Obstructive jaundice was induced by ligation of the distal common bile duct. After one week, a 2.5-cm long jejunal tube was fabricated from a segment of the loop removed 15 cm from the Treitz angle and interposed between the common bile duct and duodenum. Results: The animals presented good clinical evolution and no complications were observed. After 6 weeks, complete integration was noted between the bile duct mucosa, tube and duodenum and a significant reduction in total bilirubin and alkaline phosphatase was observed when compared to the values obtained one week after ligation of the common bile duct. Conclusion:The jejunal tube interposed between the dilated bile duct and duodenum showed good anatomic integration and reduced total bilirubin and alkaline phosphatase levels in the animals studied. Key words: Biliary tract surgical procedures. Choledochostomy. Jaundice, obstructive. Dogs. RESUMO Objetivo:Interposição de um tubo de jejuno entre o colédoco e o duodeno. Métodos: Foram utilizados cinco cães adultos, sem raça definida, de ambos os sexos, com peso médio de 22,3 Kg (18 e 26,5 Kg). Após provocar icterícia obstrutiva pela ligadura do colédoco distal, após uma semana, praticou-se confecção do tubo de jejuno de 2,5 cm de extensão, que foi realizado com um segmento de alça retirado a 15 cm do ângulo de Treitz e a interposição do tubo entre o colédoco e o duodeno. Resultados: Os animais tiveram boa evolução clínica e não apresentaram complicações. Notouse total integração entre a mucosa da via biliar, do tubo e do duodeno e redução significativa dos valores da bilirrubina total e da fosfatase alcalina após seis semanas, quando comparado com os valores após uma semana de ligadura do colédoco. Conclusão: O tubo de jejuno interposto entre a via biliar dilatada e o duodeno, apresentou boa integração anatômica e reduziu os níveis de bilirrubina total e fosfatase alcalina dos animais estudados. Descritores: Procedimentos cirúrgicos do trato biliar. Coledocostomia. Icterícia obstrutiva. Cães.

Comparative study between ligature with thread or metallic clamping by means of laparoscopy with the purpose of experimental biliary obstruction in swines

“…But, seven days after the procedure for biliary obstruction, the animals showed strongly yellow urine, skin and mucous membranes icteric, ranging from mild to severe; stools lighter shade than that observed before ligation, so as to hepatomegaly palpation. Signs compatibles with what is described on cholestasis in humans 1,48,49 , dogs 9,18 , mices 20 and rats 22,23 . However, in less time than that observed in other animal species researchs 20,22 .…”

“…However, in recent years, there was an increase in the diagnosis of asymptomatic lithiasis due to upgrading diagnostic methods routinely performed in patients [14][15][16][17] . Because of its frequency, many researchs are conducted to expand the knowledge about the pathogenesis and improving treatment of this disease 14,15,[18][19][20][21][22][23][24] . The treatment of biliary obstructions depends on the time between occurrence and diagnosis of the injury and, the type, extent and location of same in the bile ducts 14,25 , being the surgical treatment the most recommended 2,26 .…”

“…Assess any changes in liver and biliary tree due to biliary obstruction is of great importance, because it aids in clinical diagnosis of the patient, improving the quality and efficiency of treatment. For this, is required the development of experimental works, both to deepen knowledge of anatomy or in search for an ideal model for research as, also, for training and capacity of the surgeon to intervene surgically in the biliary tree 18,20,21,25,27,28,33 . In order to seek a physiological and anatomical reconstruction more suitable for extensive lesions of the biliary tree, was proposed a study of biliary reconstruction by interposing a conduit derived from a segment of small intestine, similar to the one that Monti and collaborators have proposed for urinary diversion with continence mechanisms 34,35 .…”

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“…After 6 weeks, complete integration was noted between the bile duct mucosa, tube, and duodenum. 26,27 Ebata and associates used the pedicled omentum for cholangioplasty. After 5 weeks, histologically, ordinary biliary epithelium overlaid the surface of the grafted omentum, showing that the omentum can obviously accelerate the healing of the bile duct.…”

Restoration and reconstruction of extrahepatic bile ducts in high strictures using enteric autotransplant of variable diameter

“…Они после рассечения кишки по противобрыжеечному краю получали прямоугольный лоскут кишечной стенки и сшивали его противоположные концы [10,20]. Дистальный анастомоз формировали с ДПК.…”