title: Development of a novel reflux-free bilioenteric anastomosis procedure by using a bioabsorbable polymer tube.
abstract: 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.
authors.affiliation: Gastrointestinal Center, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
authors.forename: Masayasu
authors.initials: M
authors.lastname: Aikawa
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Miyazawa
authors.forename: Katsuya
authors.initials: K
authors.lastname: Okada
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Toshimitsu
authors.forename: Kojun
authors.initials: K
authors.lastname: Okamoto
authors.forename: Naoe
authors.initials: N
authors.lastname: Akimoto
authors.forename: Isamu
authors.initials: I
authors.lastname: Koyama
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Ikada
mesh_terms: 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
chemical_list: D053552:Keratin-7; D000681:Amylases