Original Communications| Volume 132, ISSUE 3, P480-486, September 2002

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Small intestinal submucosa as a bioscaffold for biliary tract regeneration


      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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        • Lillemoe KD
        • Melton GB
        • Cameron JL
        • Pitt HA
        • Campbell KA
        • Talamini MA
        • et al.
        Postoperative bile duct strictures: management and outcome in the 1990s.
        Ann Surg. 2000; 232: 430-441
        • Longmire Jr, WP
        Early management of injury to the extrahepatic biliary tract.
        JAMA. 1966; 195: 623-625
        • Dogliotti AM
        • Fogliati E
        Operations for fibrous stenosis of the common bile duct.
        Surgery. 1954; 36: 69
        • Tocchi A
        • Mazzoni G
        • Liotta G
        • Lepre L
        • Cassini D
        • Miccini M
        Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease: a follow-up study of more than 1,000 patients.
        Ann Surg. 2001; 234: 210-214
        • Lord JW
        • Chenoweth AI
        Free graft over a Vitallium tube for bridging a gap in the bile duct of the dog.
        Arch Surg. 1943; 46: 245-252
        • Hooper JH
        • Shackelford RT
        Experimental replacement of the common bile duct.
        Arch Surg. 1962; 85: 166-170
        • Bergan JJ
        • Anderson M
        • Lounsbury FB
        Vascularized polyvinyl sponge prosthesis. Its use to replace the canine common bile duct.
        Arch Surg. 1962; 84: 49-53
        • Mendelowitz DS
        • Beal JM
        Expanded polytetrafluoroethylene in reconstruction of the canine biliary system.
        Am J Surg. 1982; 143: 221-224
        • Hartung H
        • Kirchner R
        • Baba N
        • Waldmann D
        • Strecker EP
        Histological, laboratory, and X-ray findings after repair of the common bile duct with a Teflon graft.
        World J Surg. 1978; 2: 639-642
        • Gulati SM
        • Iyengar B
        • Thusoo TK
        • Pan Dey KK
        Use of Dacron velour in choledochoplasty. An experimental study.
        Am Surg. 1983; 49: 440-445
        • Kirby CK
        • Gitts WT
        Reconstruction of the bile ducts with an isolated segment of jejunum: an experimental study.
        Arch Surg. 1950; 61: 462-468
        • Myers RT
        • Meredith JH
        • Rhodes J
        • Gilbert JW
        The fate of free grafts in the common bile duct.
        Ann Surg. 1960; 151: 776-782
        • Belzer FO
        • Watts JM
        • Ross HB
        • Dunphy JE
        Auto-reconstruction of the common bile duct after venous patch graft.
        Ann Surg. 1965; 162: 346-355
        • Ellis H
        • Hoile RW
        Vein patch repair of the common bile duct.
        J R Soc Med. 1980; 73: 635-637
        • Schatten WE
        • Cramer LW
        • Herbsman H
        • Swarm RL
        Experimental reconstruction of the common bile duct with split thickness skin graft.
        Surg Gynecol Obstet. 1957; 42: 747-753
        • Ginsburg N
        • Speese J
        Autogenous fascial reconstruction of the bile duct.
        Ann Surg. 1916; 64: 753-754
        • Leary HJ
        • Kelley GE
        • Michaels WL
        The use of preserved bile duct homografts to bridge common duct defects.
        Surgery. 1953; 34: 238-244
        • Sedgwick CE
        Reconstruction of the common bile duct with a free ureteral graft.
        Surg Gynecol Obstet. 1951; 92: 571-573
        • Santos M
        • Smith ML
        • Hughes CW
        • Riley PA
        Reconstruction of the bile ducts: an experimental study using free arterial grafts and nylon mesh tubes.
        Surgery. 1957; 42: 462-473
        • Chen MK
        • Badylak SF
        Small bowel tissue engineering using small intestinal submucosa as a scaffold.
        J Surg Res. 2001; 99: 352-358
        • Kropp BP
        • Rippy MK
        • Badylak SF
        • Adams MC
        • Keating MA
        • Rink RC
        • et al.
        Regenerative urinary bladder augmentation using small intestinal submucosa: urodynamic and histopathologic assessment in long-term canine bladder augmentations.
        J Urol. 1996; 155: 2098-2104
        • Badylak SF
        • Lantz GC
        • Coffey A
        • Geddes LA
        Small intestinal submucosa as a large diameter vascular graft in the dog.
        J Surg Res. 1989; 47: 74-80
        • Badylak SF
        Small intestinal submucosa: a biomaterial conductive to smart tissue remodeling.
        Tissue Engineering: Current Perspectives. 1993; 179: 89
        • Cobb MA
        • Badylak SF
        • Janas W
        • Simmons-Byrd A
        • Boop FA
        Porcine small intestinal submucosa as a dural substitute.
        Surg Neurol. 1999; 51: 99-104
        • Prevel CD
        • Eppley BL
        • Summerlin DJ
        • Sidner R
        • Jackson JR
        • McCarty M
        • et al.
        Small intestinal submucosa: utilization as a wound dressing in full-thickness rodent wounds.
        Ann Plast Surg. 1995; 35: 381-388
        • Liatsikos EN
        • Dinlenc CZ
        • Kapoor R
        • Alexianu M
        • Yohannes P
        • Anderson AE
        • et al.
        Laparoscopic ureteral reconstruction with small intestinal submucosa.
        J Endourol. 2001; 15: 217-220
        • Dalla Vecchia L
        • Engum S
        • Kogon B
        • Jensen E
        • Davis M
        • Grosfeld J
        Evaluation of small intestine submucosa and acellular dermis as diaphragmatic prostheses.
        J Pediatr Surg. 1999; 34: 167-171
        • Lantz GC
        • Badylak SF
        • Coffey AC
        • Geddes LA
        • Blevins WE
        Small intestinal submucosa as a small-diameter arterial graft in the dog.
        J Invest Surg. 1990; 3: 217-227
        • Lantz GC
        • Badylak SF
        • Coffey AC
        • Geddes LA
        • Sandusky GE
        Small intestinal submucosa as a superior vena cava graft in the dog.
        J Surg Res. 1992; 53: 175-181
        • Lantz GC
        • Badylak SF
        • Hiles MC
        • Coffey AC
        • Geddes LA
        • Kokini K
        • et al.
        Small intestinal submucosa as a vascular graft: a review.
        J Invest Surg. 1993; 6: 297-310
        • Kropp BP
        • Eppley BL
        • Prevel CD
        • Rippy MK
        • Harruff RC
        • Badylak SF
        • et al.
        Experimental assessment of small intestinal submucosa as a bladder wall substitute.
        Urology. 1995; 46: 396-400
        • Peel SAF
        • Chen H
        • Renlund R
        • Badylak SF
        • Kandel RA
        Formation of a SIS Cartilage composite graft in vitro and its use in the repair of articular defects.
        Tissue Eng. 1998; 4: 143-155
        • Badylak SF
        • Kokini K
        • Tullius B
        • Whitson B
        Strength over time of a resorbable bioscaffold for body wall repair in a dog model.
        J Surg Res. 2001; 99: 282-287
        • Lewin GA
        Repair of a full thickness corneoscleral defect in a German shepherd dog using porcine small intestinal submucosa.
        J Small Anim Pract. 1999; 40: 340-342
        • Wallace E
        Injectable collagen for tissue augmentation.
        in: : CRC Press, Boca Raton1988: 118-124
        • McPherson TB
        • Badylak SF
        Characterization of fibronectin derived from porcine small intestinal submucosa.
        Tissue Eng. 1998; 4: 75-83
        • Voytik-Harbin SL
        • Brightman AO
        • Kraine MR
        • Waisner B
        • Badylak SF
        Identification of extractable growth factors from small intestinal submucosa.
        J Cell Biochem. 1997; 67: 478-491
        • Rutledge RH
        Methods of repair of noncircumferential bile duct defects.
        Surgery. 1983; 93: 333-342