Development of a novel reflux-free bilioenteric anastomosis procedure by using a bioabsorbable polymer tube.
BACKGROUND
Bilioenteric anastomosis allows reflux of bowel fluid into bile ducts, resulting in reflux cholangitis. We sought to develop a reflux-free procedure of bilioenteric anastomosis endowed using an artificial bile duct (ABD).


METHODS
The study was performed in four groups of pigs. In Group A, end-to-side choledochoduodenostomy using the interposed ABD with its distal end wrapped by the duodenal seromuscular layer was performed. In Group B, conventional end-to-side choledochoduodenostomy using the ABD was performed. In Group C, conventional end-to-side choledochoduodenostomy was performed. In Group D, sham operation was performed. In each groups, 12 weeks later, animals were evaluated.


RESULTS
Bile amylase levels were significantly lower in Group A (36.9 +/- 21.7 U/L) compared with Group B (469 +/- 140.9 U/L). No significant differences were observed in bile amylase levels between Groups A and D or between Groups B and C. On histology, the neo-bile duct in Group A was covered with the duodenal muscular layer at the orifice into the intestinal tract.


CONCLUSIONS
This study suggests that the ABD is useful in the regeneration of extrahepatic bile ducts and that to bury the ABD in the duodenum can be a preventive measure against reflux of bowel fluid to bile ducts.
Aikawa
Masayasu
M
Gastrointestinal Center, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
Miyazawa
Mitsuo
M
Okada
Katsuya
K
Toshimitsu
Yasuko
Y
Okamoto
Kojun
K
Akimoto
Naoe
N
Koyama
Isamu
I
Ikada
Yoshito
Y
D020341:Absorbable Implants; D000681:Amylases / Q000378:metabolism; D000714:Anastomosis, Surgical / Q000295:instrumentation* / Q000379:methods; D000818:Animals; D001646:Bile / Q000737:chemistry; D017734:Bile Ducts, Extrahepatic / Q000601:surgery; D002768:Choledochostomy; D004386:Duodenum / Q000601:surgery; D005260:Female; D053552:Keratin-7 / Q000378:metabolism; D015607:Stents; D013552:Swine
D053552:Keratin-7; D000681:Amylases