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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

Postoperative endoscopic picture: Showing the duodenal papilla with both the stent and the balloon catheter passing through the papillary orifice.
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Figure 16: Postoperative endoscopic picture: Showing the duodenal papilla with both the stent and the balloon catheter passing through the papillary orifice.

Mentions: Results of the first clinical case: the patient showed clinical improvement within one week and discharged from the hospital within ten days. Liver functions showed improvement within two weeks. Four weeks after the operation, standard ERCP showed patent anastomoses between the gastric tube from one side and the proximal and distal CBD ends from the other side (Figure 16 and 17). The patient had been followed up for five months with no reported biliary complications.


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)

Postoperative endoscopic picture: Showing the duodenal papilla with both the stent and the balloon catheter passing through the papillary orifice.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 16: Postoperative endoscopic picture: Showing the duodenal papilla with both the stent and the balloon catheter passing through the papillary orifice.
Mentions: Results of the first clinical case: the patient showed clinical improvement within one week and discharged from the hospital within ten days. Liver functions showed improvement within two weeks. Four weeks after the operation, standard ERCP showed patent anastomoses between the gastric tube from one side and the proximal and distal CBD ends from the other side (Figure 16 and 17). The patient had been followed up for five months with no reported biliary complications.

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