Expanded polytetrafluoroethylene in reconstruction of the canine biliary system

Mendelowitz, David S.; Beal, John M.

doi:10.1016/0002-9610(82)90073-3

Cited by 29 publications

(22 citation statements)

References 13 publications

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“…Multiple experimental trials have been reported replacing the biliary defects with a variety of materials but failed to support the usefulness of these materials. [22][23][24][25][26][27] Our new procedure utilizing IVGT interposition has the advantage of being physiologic keeping normal path of bile and keeping the sphincter of Oddi's function thus maintaining a normal anatomy without reflux. Even when performing anastomosis with the duodenum reflux is not pronounced as the size of stoma is small (<10 mm) and the stoma is designed projecting into the lateral wall of the middle of the second part of duodenum to be amenable for ERCP examination if required.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic bile duct injury repair using isolated vascularized gastric tube: early experience in two tertiary centers

Helmy

Ali

2017

Int Surg J

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INTRODUCTIONAbout 80% of BDI occur after cholecystectomy constituting a catastrophe for both the patient and the surgeon as they are associated with significant morbidity and mortality, reducing long-term survival and quality of life, and are associated with high rates of subsequent litigation.1,2 Laparoscopic cholecystectomy (LC) has largely replaced open cholecystectomy (OC) but its potential disadvantage is a 2-fold increase in BDI. Moreover, injuries after LC are more proximal, are revealed earlier, are presented by leaks more than by strictures, are repaired more frequently by nonspecialists, and more associated with lost segment and ischemia due to combined vascular injury.3 Most of BDI present as biliary stricture, external or internal fistula, and biliary peritonitis. 4 If left untreated BDI may be complicated with biliary strictures, hepatic atrophy, cholangitis and intra-hepatic lithiasis. Later, fibrosis or even secondary biliary cirrhosis and portal hypertension can develop, enhanced by prolonged biliary obstruction associated with recurrent cholangitis.5 Also there is ABSTRACT Background: Bile duct injuries (BDI) constitute a disaster for both the patient and the surgeon without satisfactory results with the classic use of roux-en-Y hepaticojejunostomy (RYHJ). The purpose of this study was to evaluate our newly introduced technique utilizing isolated vascularized gastric tube (IVGT) as an alternative for RYHJ in reconstruction of the bile duct after iatrogenic BDI with lost segment. Methods: This is a prospective study included 18 consecutive patients suffered from iatrogenic BDI with lost segment admitted to Assiut and Sohag University Hospitals, during the period from September 2013 to June 2016. Patients were subjected to operative treatment with the interposition of IVGT to bridge the lost bile duct segment. Patients were evaluated regarding demographic criteria, clinical picture, different investigations, efficacy of the use of IVGT and evaluation of post-operative complications after a mean follow-up of 2 years. Results: Eighteen patients underwent repair of BDI utilizing IVGT during the study period. Three patients (17%) suffered immediate repairs, 10 patients (55%) experienced intermediate repairs and late repairs were performed for the last 5 patients (28%). Bile leak as a specific early morbidity was present in 3 patients (17%) with upper biliary tract injury without any operative mortality. Also, there was one patient with stent obstruction relieved by stent extraction. With long-term follow-up there was not any patient of biliary stricture. Conclusions: IVGT proved to be feasible and safe for bile duct replacement and is a good alternative for biliary reconstruction being more anatomical and physiological than RYHJ.

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Section: Discussionmentioning

confidence: 99%

Iatrogenic bile duct injury repair using isolated vascularized gastric tube: early experience in two tertiary centers

Helmy

Ali

2017

Int Surg J

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“…[8][9][10] These studies suggest that the best material for duct repair is autologous tissue resistant to bile, so we chose the tubular gastric wall in the present study.…”

Section: Discussionmentioning

confidence: 99%

A Promising Method for Repairing Low-Level Biliary Strictures After Cholecystectomy

Cheng

Huang

Dong

2015

International Surgery

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The purpose of this study is to introduce and evaluate a new technique of repairing bile ducts by the tubular gastric wall with a vascularized pedicle. Both the end-to-end bile duct repair and Roux-en-Y hepatoenterostomy have limitations in the treatment of benign bile duct strictures after cholecystectomy. There are no other good choices to manage these cases, especially the bile duct transection injuries or partly missing common bile duct or hepatic duct. Eleven patients with partly missing common bile ducts in the Chinese People's Liberation Army General Hospital between January 2007 and December 2012 were retrospectively analyzed. The study comprised 8 females and 3 males, whose age ranged from 29 to 56 years. All patients underwent successful bile duct repair. The time of operations ranged from 210 minutes to 240 minutes. The maximal blood loss was less than 220 ml. There was no perioperative mortality and no case of gastric fistula. Postoperative complications occurred in 3 patients, including wound infection, bile leakage, and erosive gastritis. All complications were cured by conservative treatment. The mean follow-up time was 42 months. One patient was classified as Terblanche's grade II and 10 patients were classified as Terblanche's grade I. The observations indicate that this technique is a feasible and effective choice to manage low level biliary stricture after cholecystectomy, especially suitable to repair bile duct transection injuries or partly missing common bile duct or hepatic duct.

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“…However, many series failed to support the usefulness of these materials when placed in the extra hepatic canine biliary tract. Mandelowits and Beal [8] used expanded polytetrafluoroethylene in reconstruction of the canine biliary system of eleven mongrel dogs. They found that the Teflon graft was inadequate due to rejection and fibrosis resulting in partial or complete obstruction of the duct.…”

Section: Discussionmentioning

confidence: 99%

Novel technique for biliary reconstruction using an isolated gastric tube with a vascularized pedicle: a live animal experimental study and the first clinical case

et al. 2011

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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.

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Expanded polytetrafluoroethylene in reconstruction of the canine biliary system

Cited by 29 publications

References 13 publications

Iatrogenic bile duct injury repair using isolated vascularized gastric tube: early experience in two tertiary centers

Iatrogenic bile duct injury repair using isolated vascularized gastric tube: early experience in two tertiary centers

A Promising Method for Repairing Low-Level Biliary Strictures After Cholecystectomy

Novel technique for biliary reconstruction using an isolated gastric tube with a vascularized pedicle: a live animal experimental study and the first clinical case

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