title: A hinged metalloplastic anastomotic device: a novel method for choledochoduodenostomy.
abstract: BACKGROUND
  In biliary obstruction, the creation of a large-diameter permanent fistula between the bile duct and the duodenum would be attractive.
  
  
  OBJECTIVE
  To invent, prototype, and test a new method of forming a biliary duodenal anastomosis.
  
  
  METHODS
  Survival and nonsurvival porcine model.
  
  
  METHODS
  An animal laboratory with general anesthesia.
  
  
  METHODS
  A novel hybrid metalloplastic 7F anastomosis device that consisted of a central ferrous metallic tube sandwiched between 2 tapered flexible plastic end pieces was used. The device was hinged on either side of the metal insert so that a magnetic force could form an anastomosis and then the plastic components of the device could deform to fall through the compression anastomosis. These devices were inserted into the bile duct of the pigs over a 0.035-inch guidewire with a pusher tube. Cylindrical-shaped magnets were then positioned over the intraduodenal bile duct so that they exerted compressive ischemic force on the duodenum and bile duct above the papilla.
  
  
  METHODS
  Choledochoduodenal anastomoses created were inspected at subsequent endoscopy and postmortem for patency and size.
  
  
  RESULTS
  Seven anastomosis devices were placed in the bile duct of pigs (weight 22-54 kg). All 4 survival animals were well and eating as soon as they were awake. Anastomoses were successfully accomplished in all survival animals. The supra-ampullary opening into the bile duct ranged from 5 to 10 mm.
  
  
  CONCLUSIONS
  The small number of animals.
  
  
  CONCLUSIONS
  A new method for achieving larger-diameter biliary drainage was developed. Four animals were euthanized after 2 to 7 days. Our best anastomosis resulted from 2 magnets left in the animals for 4 days.
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8019, USA. priya.jamidar@yale.edu
authors.forename: Priya
authors.initials: P
authors.lastname: Jamidar
authors.forename: Margherita
authors.initials: M
authors.lastname: Cadeddu
authors.forename: Alexander
authors.initials: A
authors.lastname: Mosse
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Swain
mesh_terms: D000818:Animals; D002768:Choledochostomy / Q000295:instrumentation* / Q000379:methods*; D016145:Endoscopy, Digestive System; D023421:Models, Animal; D013552:Swine