title: Biliary reconstruction is enhanced with a collagen-polyethylene glycol sealant.
abstract: Bile leaks occur in up to 27 per cent of liver transplant patients after biliary reconstruction. Synthetic sealants have not been investigated for these biliary procedures. We performed a randomized controlled study to evaluate a novel absorbable polyethylene glycol/collagen biopolymer sealant (CT3 Surgical Sealant) after incomplete end-to-end choledochocholedochostomy (CDCD) in pigs. Pigs (n = 18) underwent transection of the common bile duct and incomplete CDCD over a T-tube, leaving a one-sixth circumferential defect anteriorly. Animals were randomly assigned to treatment (CDCD with sealant, n = 9) or control (no sealant, n = 9). Drains were used to monitor leak volume and bilirubin (bili) concentration. Cholangiography was performed on postoperative day 3. Leaks were defined as drain bili/serum bill > 3, total drain output > 10 mL/kg, and/or extravasation on cholangiography. Animals sacrificed at 3 and 8 weeks (n = 4 and n = 5 from each group, respectively) underwent pathologic examination of the CDCD site. Statistical methods included Student's t test, chi2, linear regression, and analysis of variance procedures. The control group had a higher drain output rate over the first 4 postoperative days than the treatment group (P < 0.05, analysis of variance). Five of nine (56%) control and one of nine (11%) treatment animals had a bile leak (P < 0.05, chi2). There was no major inflammatory response to the sealant versus controls. We conclude that CT3 is effective in decreasing biliary leaks in an incomplete CDCD porcine model with no major adverse pathologic changes. This sealant should be considered for trials for biliary reconstruction in humans.
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-4753, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Wise
authors.forename: L James
authors.initials: LJ
authors.lastname: Wudel
authors.forename: Andrey E
authors.initials: AE
authors.lastname: Belous
authors.forename: Tara M
authors.initials: TM
authors.lastname: Allos
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Kuhn
authors.forename: Irene D
authors.initials: ID
authors.lastname: Feurer
authors.forename: M Kay
authors.initials: MK
authors.lastname: Washington
authors.forename: C Wright
authors.initials: CW
authors.lastname: Pinson
authors.forename: William C
authors.initials: WC
authors.lastname: Chapman
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D003094:Collagen / Q000627:therapeutic use*; D003135:Common Bile Duct / Q000473:pathology / Q000601:surgery*; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011897:Random Allocation; D013501:Surface-Active Agents / Q000627:therapeutic use*; D013552:Swine; D014014:Tissue Adhesives / Q000627:therapeutic use*
chemical_list: D013501:Surface-Active Agents; D014014:Tissue Adhesives; D011092:Polyethylene Glycols; D003094:Collagen