Abstract
Background. Porcine small intestinal submucosa (SIS) biograft is used as a bioscaffold for regeneration
of a variety of tissues. To date, SIS has not been used as a biliary tract graft.
The purpose of this study was to evaluate the feasibility of using SIS as a scaffold
for bile duct tissue regeneration in a canine model. Methods. Fifteen, 25- to 35-kg mongrel dogs underwent midline laparotomy and exposure of the
common bile duct. Nine dogs had a longitudinal choledochotomy and a 2- × 1-cm elliptical
patch of 4-ply SIS placed using 6-0 polypropylene suture. Six dogs had the anterior
two thirds of the bile duct resected and a 2- to 3-cm tubularized 4-ply SIS interposition
graft placed. Dogs were killed at intervals ranging from 2 weeks to 5 months. Before
killing, liver function tests (alkaline phosphatase [U/L] and total bilirubin [mg/dL])
were evaluated, cholangiograms were performed, and the bile duct was examined histologically.
Results. Fourteen out of 15 dogs survived and were healthy at the time of killing. The one
failure was a result of a bile leak in a patched animal. The SIS showed signs of incorporation
with infiltration of native fibroblasts, blood vessels, and biliary mucosa within
2 weeks. Within 3 months the SIS graft was replaced with native collagen covered with
a biliary epithelium. No changes occurred at 5-month follow-up. One animal with an
interposition graft developed a stricture at the proximal anastomosis within 2 months.
In the remaining dogs, liver enzymes were normal, and the caliber of the common bile
duct remained normal. Conclusions. SIS can be used for regeneration of bile duct tissue in a canine model. In 13 of
15 dogs SIS resulted in regeneration of canine common bile duct when used as a patch
or as an interposition graft. The potential for the use of SIS as a patch for biliary
stricturoplasty, or as an interposition graft for repair of complex biliary injuries
is encouraging. (Surgery 2002;132:480-6.)
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Article info
Publication history
Accepted:
May 5,
2002
Footnotes
*Reprint requests: Jeffrey Ponsky, MD, 9500 Euclid Ave, Desk A-80, Cleveland Clinic Foundation, Cleveland OH 44195.
Identification
Copyright
© 2002 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
