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

Helmy AA, Hamad MA, Aly AM, Sherif T, Hashem M, El-Sers DA, Semieka M - Ann Surg Innov Res (2011)

Bottom Line: In the first clinical case, the patient showed clinical and biochemical improvement.Endoscopic retrograde cholangiography was feasible and assured patent biliary anastomoses.The technique is also feasible in human and seems to be promising.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt. mostafa_hamad@yahoo.com.

ABSTRACT

Background: Biliary 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.

Methods: Seven 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.

Results: One 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.

Conclusion: In 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.

No MeSH data available.


Related in: MedlinePlus

Microscopic examination: Showing the anastomotic site between the pedicled gastric tube and duodenum, ×10.
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Figure 14: Microscopic examination: Showing the anastomotic site between the pedicled gastric tube and duodenum, ×10.

Mentions: Six weeks after the procedure, the abdomen was explored again under general anesthesia for any biliary leak, intraabdominal collection, disrupted anastomosis or anastomotic stricture. An operative specimen was obtained including the liver, extra hepatic biliary channels, gastric tube, duodenum and stomach before sacrifice of the animal (Figure 9). Grossly, we measured the circumference of the anastomoses of the gastric tube with both CBD and duodenum (Figure 10 and 11). Thereafter, the specimens had been fixed in 10% formalin for 24 hours before they were trimmed. Sections were routinely processed. Five micron-thick sections were cut from paraffin blocks, and stained with hematoxylin and eosin stain for histological examination (Figure 12, 13, 14 and 15).


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

Helmy AA, Hamad MA, Aly AM, Sherif T, Hashem M, El-Sers DA, Semieka M - Ann Surg Innov Res (2011)

Microscopic examination: Showing the anastomotic site between the pedicled gastric tube and duodenum, ×10.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3198750&req=5

Figure 14: Microscopic examination: Showing the anastomotic site between the pedicled gastric tube and duodenum, ×10.
Mentions: Six weeks after the procedure, the abdomen was explored again under general anesthesia for any biliary leak, intraabdominal collection, disrupted anastomosis or anastomotic stricture. An operative specimen was obtained including the liver, extra hepatic biliary channels, gastric tube, duodenum and stomach before sacrifice of the animal (Figure 9). Grossly, we measured the circumference of the anastomoses of the gastric tube with both CBD and duodenum (Figure 10 and 11). Thereafter, the specimens had been fixed in 10% formalin for 24 hours before they were trimmed. Sections were routinely processed. Five micron-thick sections were cut from paraffin blocks, and stained with hematoxylin and eosin stain for histological examination (Figure 12, 13, 14 and 15).

Bottom Line: In the first clinical case, the patient showed clinical and biochemical improvement.Endoscopic retrograde cholangiography was feasible and assured patent biliary anastomoses.The technique is also feasible in human and seems to be promising.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt. mostafa_hamad@yahoo.com.

ABSTRACT

Background: Biliary 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.

Methods: Seven 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.

Results: One 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.

Conclusion: In 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.

No MeSH data available.


Related in: MedlinePlus