To the Editors:
We read with interest the article by Rosen et al
1.
and would like to address some points.Stricture formation is a common complication of bile duct repair even when autologous tissues are used, as is the case in biliary-enteric anastomosis. Small intestine submucosa (SIS) interposition graft has sutures in both ends, longitudinally closing the edges of the graft. We worked with a similar model, and our stricture formation reached 40% due to the excessive sutures utilization.
2.
In their study, 1 dog of 5 developed a stricture at 2 months (20%). Therefore, we believe this model cannot be established as safer than other methods of bile duct repair. The authors also mention that the other studies of bile duct repair have largely failed, a statement that cannot be accepted. In their experimental trials of bile duct replacement with polytetrafluoroethylene (PTFE), Ruka et al3.
and Mendelowitz and colleagues4.
reported bile stasis owing to extrinsic compression of the grafts. We reported that thin-walled PTFE grafts reinforced with rigid rings achieved satisfactory bile drainage and no stricture formation after repair of partial and complete common bile duct transections.5.
Epithelial regeneration and neovascularization occurred with PTFE and human dura mater, suggesting that this phenomenon is shared also in other types of grafts.2.
, 5.
, 6.
We congratulate the authors for their effort in this type of work. SIS seems to be an acceptable option, but further studies are needed to establish its true benefits and rate of complications.
References
- Small intestinal submucosa as a bioscaffold for biliary tract regeneration.Surgery. 2002; 132: 480-486
- Experimental replacement of a cervical esophagic segment with liofilized human duramadre tube.Dig Dis Sci. 1986; 31: 387S
- Expanded polytetrafluoroethylene grafts in restoring bile drainage in dogs.Z Exp Chir Transplant Kunstl. 1987; 6: 317-323
- Expanded polytetrafluoroethylene in reconstruction of the canine biliary system.Arch Surg. 1982; 143: 221-224
- Repair of bile duct injuries with Gore-Tex vascular grafts: experimental study in dogs.J Gastrointest Surg. 2002; 6: 116-120
- Repair of full-thickness defects in alimentary tract wall with patches of expanded polytetrafluoroethylene.Ann Surg. 2002; 235: 708-712
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© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
