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2008, Number 6

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Rev Med Inst Mex Seguro Soc 2008; 46 (6)

Histological Evaluation of Hepatic Fibrosis in Patients with Post Surgical Bile Duct Injury

Hermosillo-Sandoval JM, Ramírez-Casillas V, Hernández-Hoyos S, Osuna-Rubio J, Nuño-Guzmán CM, Gálvez-Gastélum FJ, Miranda-Díaz AG

Language: Spanish
References: 21
Page: 663-668
PDF size: 981.02 Kb.


ABSTRACT

Background: bile duct injuries after cholecystectomy can produce fibrous and collagen deposit tissue. Our objective was to evaluate the liver fibrosis measured in histological tissue in patients with bile duct injury after cholecystectomy.
Methods: three normal liver biopsies and 21 from patients with bile duct injuries were studied. Group I: with three normal liver biopsies. Group II: with external abdominal fistula alone in six patients. Group III with complete bile duct obstruction in 15 patients. The surgical biliary enteric reconstructions were performed 8 weeks after bile duct injury in all cases. The fibrosis and collagen deposits were studied by Masson’s trichrome and Sirius red stains and they were measured by a digital program.
Results: group I showed 2% of fibrosis tissue and 1% of collagen deposit and was considered as normal. Group II showed unexpected 1 fold more liver fibrosis and 9 fold more collagen deposit in extracellular matrix macromolecule (p ‹ 0.05, Anova) against group I. Patients in group III, had fibrous tissue increase 43 folds more and 14 collagen folds more (p ‹ 0.0001, Bonferroni’s post hoc) versus group I.
Conclusions: the patients in groups II and III showed liver fibrosis, being this more important in group III.


REFERENCES

  1. Klar RM, Kongstvedt PR. Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy. JAMA 1993;270:1429-1442.

  2. Hines OJ, Reber HA. Invited critique: operative repair of bile duct injuries involving the hepatic duct confluence. Arch Surg 1999;134(7):775.

  3. Gottlieb S. Injury to bile duct during cholecystectomy nearly triples risk of death. Br Med J 2003; 327(7421):946.

  4. Arnaud A, Fontana L, Angulo AJ, Gil A, López- Pedrosa JM. Proliferation, functionality and extracellular matrix production of hepatocytes and a liver stellate cell line: a comparison between single cultures and cocultures. Dig Dis S 2003;48(7): 1406-1413.

  5. Malhi H, Gores GJ, Lemasters JJ. Apoptosis and necrosis in the liver: a tale of two deaths? Hepatology 2006;43:S31-S44.

  6. Bleier JI, Katz SC, Chaudhry UI, Pillarisetty VG, Kingham TP 3rd, Shah AB, et al. Biliary obstruction selectively expands and activates liver myeloid dendritic cells. J Immunol 2006;176:7189-7195.

  7. Miranda-Díaz A, Rincón AR, Salgado S, Vera- Cruz J, Gálvez J, Islas MC, et al. Effects of viral gene delivery of human uPA plus biliodigestive anastomosis induce recovery from experimental biliary cirrhosis. Mol Ther 2004;9:30-37.

  8. Ishak K, Baptista A, Bianchi L. Histological grading and staging of chronic hepatitis. J Hepatol 1995;22:696-699.

  9. Salgado S, García J, Vera J, Siller F, Bueno M, Miranda A, et al. Liver cirrhosis is reverted by urokinasetype plasminogen activator gene therapy. Mol Ther 2000;2(6):545-551.

  10. López-de León, Rojkind MA. Simple micromethod for collagen and total protein determination in formalin-fixed paraffin-embedded sections. J Histochem Cytochem 1985;33:737-743.

  11. Melton GB, Lillemoe KD, Cameron JL, Sauter PA, Coleman J, Yeo CJ. Major Bile duct injuries associated with laparoscopic cholecystectomy: effect of surgical repair on quality of life. Ann Surg 2002;235:888-895.

  12. Kologlu M, Tutuncu T, Yuksek YN, Gozalan U, Daglar G, Kama NA. Using a risk score for conversion from laparoscopic to open cholecystectomy in resident training. Surgery 2004;135(3):282-287.

  13. Dooley JS, Dick R, Watkinson A. Multidisciplinary aproach to biliary complications of laparoscopic cholecystectomy. Br J Surg 1998;85:627-632.

  14. Hui CK, Belaye T, Montegrand K, Wright TL. A comparison in the progression of liver fibrosis in chronic hepatitis C between persistently normal and elevated transaminase. J Hepatol 2003;38: 511-517.

  15. García-Bañuelos J, Siller-López F, Miranda A, Aguilar LK, Aguilar-Córdova E, Armendáriz-Boruna J. Cirrhotic rat livers with extensive fibrosis can be safely transduced with clinical-grade adenoviral vectors. Evidence of cirrhosis reversion. Gene Ther 2002;9(2):127-134.

  16. Hemmann S, Graf J, Roderfeld M, Roeb E. Expression of MMPs and TIMPs in liver fibrosis. A systematic review with special emphasis on antifibrotic strategies. J Hepatol 2007(46):955-975.

  17. Tanano H, Hasegawa T, Kimura T, Sasaki T, Kawahara H, Kubota A, et al. Proposal of fibrosis index using image analyzer as a quantitative histological evaluation of liver fibrosis in biliary atresia. Ped Surg Int 2003;19(1-2):52-56.

  18. Sodeman T, Bronk SF, Roberts PJ. Bile salts mediate hepatocyte apoptosis by increasing cell surface trafficking of Fas. Am J Physiol Gastrointest Liver Physiol 2000;278:G992-G999.

  19. Sokol RJ, Mack C, Narkewics MR, Karrer FM. Pathogenesis and outcome of biliary atressia: current concepts. J Ped Gastr Nut 2003;37:4-21.

  20. Lloid TM, Tllett A, Gacea G, Sutton Ch. Informed consent: are basic surgical trainees meeting the standards? Qual Primary Care 2004;12:97-101.

  21. Sultana A, Byme C, Caneh P, Poston GJ. Iatrogenic bile duct injury: impact of delay in recognition and experience of surgeon undertaking definitive repair. Br J Surg 2004;91:32.




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