Background
With the recent widespread use of laparoscopic cholecystectomy and living-donor liver
transplantation, complications involving the biliary system, and stenosis in particular,
are encountered frequently. Although various invasive and noninvasive techniques are
now available for the treatment of biliary stenosis, recurrence and other problems
limit their value and utility. Our group sought to investigate whether a bioabsorbable
polymer (BAP) patch could serve as a novel treatment for biliary stenosis.
Methods
In anesthetized hybrid pigs (n = 12), a spindle-shaped portion of the lower common bile duct wall was excised, and
a BAP patch was implanted at the excision site. The animals underwent repeat laparotomy
at 5 weeks (n = 6) and at 4 months (n = 6) after implantation to recover the graft sites for gross and histologic studies.
Blood chemistry was analyzed from samples taken during the patch implantation and
recovery.
Results
All of the recipient pigs survived until killing. All gained weight and showed no
evidence of jaundice. The BAP-patched duct remained patent without obstruction at
5 weeks postimplantation. Blood chemistry did not reveal any increases in hepatobiliary
enzyme activities. Histology showed accessory glandular structures in the neo-bile
duct. At 4 months, the graft site was indistinguishable from the native duct. Intra-operative
cholangiography revealed dilation of the patched site, but no dilatation of the intrahepatic
bile ducts. Blood chemistry values were within normal ranges. Histology at the site
of the patch confirmed the growth of a cuboidal columnar epithelium similar to that
of the native duct.
Conclusion
The bile duct was dilated only focally at the site of implantation. This newly designed
substitute has potential for application as a novel treatment for biliary injury and
stenosis.
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Article info
Publication history
Published online: December 11, 2009
Accepted:
October 12,
2009
Identification
Copyright
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
