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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

Postmortem specimen: Showing anastomosis of the newly fashioned gastric tube to both the distal end of CBD and the duodenum. d) The pedicled gastric tube. f) Anastomosis of the gastric tube to the CBD at the site of confluence of the right hepatic duct. g) Right hepatic duct. h) Anastomosis of the gastric tube to the duodenum.
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Figure 9: Postmortem specimen: Showing anastomosis of the newly fashioned gastric tube to both the distal end of CBD and the duodenum. d) The pedicled gastric tube. f) Anastomosis of the gastric tube to the CBD at the site of confluence of the right hepatic duct. g) Right hepatic duct. h) Anastomosis of the gastric tube to the duodenum.

Mentions: A piece from the middle 1/3 of the greater curvature of the stomach, 10-15 cm from pylorus and 5 × 3 cm in diameter, was completely separated from the stomach with its blood supply based upon right gastroepiploic vessels which were mobilized by meticulous dissection (Figure 1, 2, 3 and 4). The resulted defect in the stomach was closed in two layers. The piece of the stomach wall was fashioned as a tube over a silicon catheter of 4 mm diameter which later acted as an anastomotic stent (Figure 5 and 6). The distal part of the CBD was anastomosed to the newly fashioned tube which in turn anastomosed to the duodenum 2-3 cm distal to the pylorus (Figure 7, 8 and 9). Both anastomoses were mucosa to mucosa using 5/0 Vicryl (Ethicon inc., Johnson & Johnson company) interrupted sutures. The posterior row of sutures was placed followed by the anterior row. The stent was fixed by a stitch of the same suture type to the CBD wall to prevent slipping and its distal tip was placed in the duodenum.


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)

Postmortem specimen: Showing anastomosis of the newly fashioned gastric tube to both the distal end of CBD and the duodenum. d) The pedicled gastric tube. f) Anastomosis of the gastric tube to the CBD at the site of confluence of the right hepatic duct. g) Right hepatic duct. h) Anastomosis of the gastric tube to the duodenum.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 9: Postmortem specimen: Showing anastomosis of the newly fashioned gastric tube to both the distal end of CBD and the duodenum. d) The pedicled gastric tube. f) Anastomosis of the gastric tube to the CBD at the site of confluence of the right hepatic duct. g) Right hepatic duct. h) Anastomosis of the gastric tube to the duodenum.
Mentions: A piece from the middle 1/3 of the greater curvature of the stomach, 10-15 cm from pylorus and 5 × 3 cm in diameter, was completely separated from the stomach with its blood supply based upon right gastroepiploic vessels which were mobilized by meticulous dissection (Figure 1, 2, 3 and 4). The resulted defect in the stomach was closed in two layers. The piece of the stomach wall was fashioned as a tube over a silicon catheter of 4 mm diameter which later acted as an anastomotic stent (Figure 5 and 6). The distal part of the CBD was anastomosed to the newly fashioned tube which in turn anastomosed to the duodenum 2-3 cm distal to the pylorus (Figure 7, 8 and 9). Both anastomoses were mucosa to mucosa using 5/0 Vicryl (Ethicon inc., Johnson & Johnson company) interrupted sutures. The posterior row of sutures was placed followed by the anterior row. The stent was fixed by a stitch of the same suture type to the CBD wall to prevent slipping and its distal tip was placed in the duodenum.

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