title: A novel technique for hepaticojejunostomy for nondilated bile ducts: a purse-string anastomosis with an intra-anastomotic biodegradable biliary stent.
abstract: In non-dilated bile ducts, performing a well-functioning hepaticojejunal anastomosis (HJ) may be challenging. We investigated a novel technique for small-caliber HJ: a purse-string anastomosis with an intra-anastomotic biodegradable stent. HJ was performed randomly either conventionally with interrupted sutures without any stent (n = 5; conventional) or using the novel purse-string technique with a 4-mm caliber polylactide-barium sulfate biodegradable biliary stent (n = 4; pursestring + stent) in minipigs with bile ducts 3.5-4.0 mm in caliber. The anastomosis creation time was not different in the groups. In the conventional group 2 complications occurred: 1 early anastomotic leakage, and 1 late anastomotic stricture. The remaining animals (3/5 in conventional, and 4/4 in purse-string + stent group) had normal liver histology and function, and developed no signs of complications during the 6-month follow-up. All biodegradable stents disappeared by 3 months. At 6 months, the HJ caliber was smaller in the conventional (5 [1-9] mm) than in the purse-string + stent group (12 [4-15] mm; P < .05). We conclude that this novel HJ technique is easy and safe to perform, and ensures a well-functioning anastomosis in nondilated bile ducts.
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, Tampere, Finland. johanna.laukkarinen@fimnet.fi
authors.forename: Johanna
authors.initials: J
authors.lastname: Laukkarinen
authors.forename: Juhani
authors.initials: J
authors.lastname: Sand
authors.forename: Jenni
authors.initials: J
authors.lastname: Leppiniemi
authors.forename: Minna
authors.initials: M
authors.lastname: Kellomäki
authors.forename: Isto
authors.initials: I
authors.lastname: Nordback
mesh_terms: D020341:Absorbable Implants; D000714:Anastomosis, Surgical / Q000295:instrumentation; D000818:Animals; D001466:Barium Sulfate; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery*; D007582:Jejunostomy / Q000295:instrumentation* / Q000379:methods; D011091:Polyesters; D015607:Stents; D013536:Suture Techniques; D013552:Swine; D013556:Swine, Miniature
chemical_list: D011091:Polyesters; D001466:Barium Sulfate; C033616:poly(lactide)