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Original communication| Volume 87, ISSUE 5, P514-523, May 1980

Cholecystojejunocholecystostomy: A new method of biliary drainage in auxiliary liver allotransplantation

  • J.H. Crosier
    Affiliations
    London, England

    From the Departments of Surgery and Pathology, and the Medical Research Council Liver Research Group, University of Cape Town, Observatory, Cape Town, Republic of South Africa

    From the Institute for Biostatistics of the South African Medical Research Council, Tygerberg, Republic of South Africa
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  • E.J. Immelman
    Correspondence
    Reprint requests: Prof. E. J. Immelman, Department of Surgery, Medical School, Observatory, Cape Town, 7925, Republic of South Africa.
    Affiliations
    London, England

    From the Departments of Surgery and Pathology, and the Medical Research Council Liver Research Group, University of Cape Town, Observatory, Cape Town, Republic of South Africa

    From the Institute for Biostatistics of the South African Medical Research Council, Tygerberg, Republic of South Africa
    Search for articles by this author
  • R. van Hoorn-Hickman
    Affiliations
    London, England

    From the Departments of Surgery and Pathology, and the Medical Research Council Liver Research Group, University of Cape Town, Observatory, Cape Town, Republic of South Africa

    From the Institute for Biostatistics of the South African Medical Research Council, Tygerberg, Republic of South Africa
    Search for articles by this author
  • C.J. Uys
    Affiliations
    London, England

    From the Departments of Surgery and Pathology, and the Medical Research Council Liver Research Group, University of Cape Town, Observatory, Cape Town, Republic of South Africa

    From the Institute for Biostatistics of the South African Medical Research Council, Tygerberg, Republic of South Africa
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  • J. van den Ende
    Affiliations
    London, England

    From the Departments of Surgery and Pathology, and the Medical Research Council Liver Research Group, University of Cape Town, Observatory, Cape Town, Republic of South Africa

    From the Institute for Biostatistics of the South African Medical Research Council, Tygerberg, Republic of South Africa
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  • J. Terblanche
    Affiliations
    London, England

    From the Departments of Surgery and Pathology, and the Medical Research Council Liver Research Group, University of Cape Town, Observatory, Cape Town, Republic of South Africa

    From the Institute for Biostatistics of the South African Medical Research Council, Tygerberg, Republic of South Africa
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  • D.J. van Schalkwyk
    Affiliations
    London, England

    From the Departments of Surgery and Pathology, and the Medical Research Council Liver Research Group, University of Cape Town, Observatory, Cape Town, Republic of South Africa

    From the Institute for Biostatistics of the South African Medical Research Council, Tygerberg, Republic of South Africa
    Search for articles by this author
DOI:https://doi.org/10.5555/uri:pii:0039606080902470
Cholecystojejunocholecystostomy: A new method of biliary drainage in auxiliary liver allotransplantation
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      Abstract

      A subhepatic, whole auxiliary liver allotransplant technique, previously developed in the pig, was assessed for technical feasibility in 26 human cadaver transplants. All technical aspects of the subhepatic technique were feasible, with the exception of donor to recipient gallbladder-to-gallbladder anastomosis, which could only be performed in 50% of subjects due to excessive separation of the two gallbladders. To overcome the problem, an original technique was developed—namely, the use of an isolated, vascularized, isoperistaltic loop of jejunum to act as a conduit between donor and recipient gallbladders (cholecystojejunocholecystostomy). Cholecystojejunocholecystostomy was subsequently developed and studied in a series of live porcine auxiliary allografts. The local, regional, and general effects seen in 14 allografted pigs with cholecystojejunocholecystostomy were compared with those seen in a parallel and identical series of 14 allografts with cholecystocholecystostomy. The subhepatic transplantation technique is described in detail for the first time. Liver biopsies, blood samples, and clinical data were obtained at weekly intervals and at 28 days all survivors were killed.
      Cholecystojejunocholecystostomy proved to be a successful method of biliary drainage in the pig. Thirteen of the 14 interposed jejunal loops were viable and essentially normal at autopsy, leaks and naked eye stasis were infrequent, and the histological incidence of intrahepatic cholangitis and cholestasis minimal. The local, regional, and general effects were comparable in every way with those obtained with cholecystocholecystostomy.
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      References

        • Battersby C
        • Egerton WS
        • Balderson G
        • et al.
        Another look at rejection in pig liver homografts.
        Surgery. 1974; 76: 617
        • Brettschneider L
        • Tong JL
        • Boose DS
        • et al.
        Specific bacteriologic problems after orthotopic liver transplantation in dogs and pigs.
        Arch Surg. 1968; 97: 313
        • Calne RY
        Observations on experimental and clinical liver transplantation.
        Transplant Proc. 1972; 4: 773
        • Calne RY
        A new technique for biliary drainage in orthotopic liver transplantation utilizing the gall bladder as a pedicle graft conduit between the donor and recipient common bile ducts.
        Ann Surg. 1976; 184: 605
        • Calne RY
        • Williams R
        Orthotopic liver transplantation: the first 60 patients.
        Br Med J. 1977; 1: 471
        • Collan Y
        • Sivula A
        • Lempinen M
        Pathology of orthotopic liver transplantation in pigs and dogs. Autopsy and biopsy studies.
        Ann Chir Gynaecol Fenniae. 1973; 62: 204
        • Crosier J
        • Immelman E
        • Hickman R
        • et al.
        A comparative study of two methods of biliary drainage in pigs subjected to auxiliary heterotopic hepatic transplantation.
        S Afr J Surg. 1975; 13 (abstract): 1
        • Crosier JH
        Auxiliary liver allotransplantation—a human feasibility study, and an evaluation of a new technique in the pig.
        in: Master of Surgery Thesis. University of Cape Town, Dec 1978
        • Dent DM
        • Hickman R
        • Uys CJ
        • et al.
        The natural history of liver allo- and autotransplantation in the pig.
        Br J Surg. 1971; 58: 407
        • Fonkalsrud EW
        • Joseph WL
        • Tocornal JA
        • et al.
        Allogeneic hepatic transplantation using cadaveric donors with clinical application.
        J Pediatr Surg. 1968; 3: 300
        • Fortner JG
        • Kinne DW
        • Shiu MH
        • et al.
        Clinical liver heterotopic (auxiliary) transplantation.
        Surgery. 1973; 74: 739
        • Fulginiti VA
        • Scribner R
        • Groth CG
        • et al.
        Infections in recipients of liver homografts.
        N Engl J Med. 1968; 279: 619
        • Hickman R
        • Crosier JH
        • Saunders SJ
        • et al.
        Transhepatic metabolism after end-to-side portacaval shunt in the young pig.
        Surgery. 1974; 76: 601
        • Hunt P
        • Cocks J
        • de Boer W
        • et al.
        Liver transplantation in the pig.
        Med J Aust. 1970; 2: 261
        • Immelman EJ
        • van Leenhof JW
        • Terblanche J
        • et al.
        The avoidance of donor atrophy in auxiliary liver allotransplantation in the pig.
        in: Eur Soc Exp Surg 7th Congr. 1972: 288 (abstract)
        • Immelman EJ
        • van Leenhoff JW
        • Saunders SJ
        • et al.
        Heterotopic liver allotransplantation in the pig.
        in: Saunders SJ Terblanche J Liver. Pitman Medical, London1973: 210 (abstract)
        • MacSween RNM
        Hepatic sepsis after liver transplantation in dogs and pigs.
        Arch Pathol. 1969; 88: 166
        • Martineau G
        • Porter KA
        • Corman J
        • et al.
        Delayed biliary duct obstruction after orthotopic liver transplantation.
        Surgery. 1972; 72: 604
        • Murray-Lyon IM
        • Evans DB
        • Foster WD
        • et al.
        Liver transplantation in man. The significance, patterns, and control of infection.
        Br J Surg. 1970; 57: 280
        • Northover JMA
        • Terblanche J
        Bile duct blood supply. Its importance in human liver transplantation.
        Transplantation. 1978; 26: 67
        • Slapak M
        • Beaudoin JG
        • Lee HM
        • et al.
        Auxiliary liver homotransplantation. A new technique and an evaluation of current techniques.
        Arch Surg. 1970; 100: 31
        • Starzl TE
        • Marchioro TL
        • Rowlands Jr, DT
        • et al.
        Immunosuppression after experimental and clinical homotransplantation of the liver.
        Ann Surg. 1964; 160: 411
        • Starzl TE
        • Marchioro TL
        • Porter KA
        • et al.
        Factors determining short- and long-term survival after orthotopic liver homotransplantation in the dog.
        Surgery. 1965; 58: 131
        • Starzl TE
        • Putnam CW
        Experience in hepatic transplantation.
        in: WB Saunders Co, Philadelphia1969: 41
        • Starzl TE
        • Porter KA
        • Schroter G
        • et al.
        Autopsy findings in a long-surviving liver recipient.
        N Engl J Med. 1973; 289: 82
        • Starzl TE
        • Ishikawa M
        • Putnam CW
        • et al.
        Progress in and deterrents to orthotopic liver transplantation, with special reference to survival, resistance to hyperacute rejection, and biliary duct reconstruction.
        Transplant Proc. 1974; 6: 129
        • Starzl TE
        • Porter KA
        • Putnam CW
        • et al.
        Orthotopic liver transplantation in ninety-three patients.
        Surg Gynecol Obstet. 1976; 142: 487
        • Starzl TE
        • Putnam CW
        • Hansbrough JF
        • et al.
        Biliary complications after liver transplantation:, with special reference to the biliary cast syndrome and techniques of secondary duct repair.
        Surgery. 1977; 81: 212
        • Stuart FP
        • Torres E
        • Hester WJ
        • et al.
        Orthotopic autotransplantation and allotransplantation of the liver: functional and structural patterns in the dog.
        Ann Surg. 1967; 165: 325
        • Terblanche J
        • Peacock JH
        • Hobbs KEF
        • et al.
        Orthotopic liver homotransplantation: an experimental study in the unmodified pig.
        S Afr Med J. 1968; 42: 486
        • Thomford NR
        • Shorter RG
        • Hallenbeck GA
        Homotransplantation of the canine liver. Survival and histology with and without azathioprine.
        Arch Surg. 1965; 90: 527
        • Waldram R
        • Williams R
        • Calne RY
        Bile composition and bile cast formation after transplantation of the liver in man.
        Transplantation. 1975; 19: 382
        • Whitehead TP
        • Whittaker SRF
        A method for the determination of glutamine in cerebrospinal fluid and the results in hepatic coma.
        J Clin Pathol. 1955; 8: 81
        • Williams R
        • Smith M
        • Shilkin KB
        • et al.
        Liver transplantation in man: the frequency of rejection, biliary tract complications, and recurrence of malignancy based on an analysis of 26 cases.
        Gastroenterology. 1973; 64: 1026

      Article info

      Publication history

      Accepted: September 13, 1979

      Footnotes

      ☆Supported in part by the Medical Research Council of South Africa, the University of Cape Town Senate Research Committee, the Harry Crossley Foundation and the J. S. Marais Memorial Fund.

      Identification

      DOI: https://doi.org/10.5555/uri:pii:0039606080902470

      Copyright

      © 1980 Published by Elsevier Inc.

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