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2013, Number 5

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Cir Cir 2013; 81 (5)

Bile duct lesions repaired with peritoneal tube grafts

leana Lorenzana-Bautista I, Flores-Plascencia A, Barrios-Pineda FJ, Alderete-Vázquez G, Sánchez-Valdivieso EA

Language: Spanish
References: 50
Page: 373-382
PDF size: 306.02 Kb.


ABSTRACT

Background: A significant number of individuals suffer iatrogenic bile duct injury during laparoscopic cholecystectomy. Biliarydigestive bypass may be complicated by stenosis and biliary sepsis, affecting both quality of life and life expectancy. To avoid bypass synthetic grafts have been used which are expensive.
Objective: Evaluating autologous implantation of peritoneus as alternative of bile duct repair.
Methods: Under general anesthesia, ten New Zealand adult rabbits were operated, common bile duct approached and sectioned underneath the cystic duct followed by a liver biopsy. An autologous graft was built of peritoneum and graft-bile duct proximal and distal end-to-end anastomosis done. Animals were followed-up by weekly bilirrubin and transferases. Rabbits were scheduled euthanized and a liver biopsy done for histological examinations.
Results: Autologous graft was easy to create and all rabbits survived. They did not develop jaundice or alterations in their normal habits. At necropsy, autologous grafts were removed and no signs of occlusion were noticed. Moderate short-term liver damage was observed but long-term damage was negligible. Bileoma and pyogenic liver abscess were observed in two animals, respectively.
Discussion: Our results favourably match well known procedures used for bile duct repair, especially in cases of severe injury (Bismuth-Strasberg E1-3): it seems less complicated than biliarydigestive bypass, not as expensive as synthetic grafts and much easier to build than human amnion graft.
Conclusion: Interposing an autologous graft of peritoneum is an easy-to-create surgical procedure and circumferential bile duct injuries were adequately repaired.


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