Comparatively lower postoperative hepatolithiasis risk with hepaticocholedochostomy versus hepaticojejunostomy.
BACKGROUND
Optimal surgical technique plays a key role in preventing the postoperative recurrence of hepatolithiasis. Tian et al developed the subcutaneous tunnel and hepatocholangioplasty using the gallbladder (STHG) technique and applied it in hepatolithiasis patients who had an approximately normal gallbladder and sphincter of Oddi. However, the technique is controversial. In the present study, a canine model was established for hepatocholangioplasty (HC) and hepaticojejunostomy (HJ) to simulate STHG and Roux-en-Y cholangiojejunostomy in the clinic, respectively. Then, the alterations of bile components in the vicinity of the anastomosis were compared. This may provide an experimental guide for choosing an optimal technique for the treatment of hepatolithiasis in the clinic.


METHODS
The animals were randomly separated into a control group (5 dogs) and a model group (stenosis of the common bile duct; 24 dogs). The 24 dogs in the model group were randomly divided into an HC group and an HJ group (12/group). Bile was collected from the bile duct at 1 and 5 months after the operation, and the bile components were determined.


RESULTS
The levels of total bile acid, cholesterol, total bilirubin, and phospholipid in the HC group were higher than those in the HJ group (P<0.05). However, no statistical difference was seen in unconjugated bilirubin and calcium ions. The mucin level in bile in the HC group was lower than that in the HJ group at 5 months after the operation (P<0.05). The postoperative lipid peroxidation level was remarkably lower than that in the HJ group (P<0.05). However, the superoxide dismutase level was remarkably higher than that in the HJ group (P<0.05). Finally, a significant difference was found in the positive bacterial culture rate in bile between the groups.


CONCLUSIONS
Changes of bile components near the anastomosis after HC might be more preferable for preventing hepatolithiasis formation than HJ.
Zhang
Xiao-Jin
XJ
Department of Hepatobiliary Surgery, Fuzong Clinical College, Fujian Medical University, Fuzhou 350025, China.
Jiang
Yi
Y
Wang
Xu
X
Tian
Fu-Zhou
FZ
Lv
Li-Zhi
LZ
D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D000818:Animals; D001646:Bile / Q000378:metabolism / Q000382:microbiology; D001647:Bile Acids and Salts / Q000378:metabolism; D001663:Bilirubin / Q000378:metabolism; D002768:Choledochostomy / Q000379:methods*; D002784:Cholesterol / Q000378:metabolism; D004195:Disease Models, Animal; D004285:Dogs; D005260:Female; D007582:Jejunostomy / Q000379:methods*; D020347:Lithiasis / Q000517:prevention & control / Q000601:surgery*; D008107:Liver Diseases / Q000517:prevention & control / Q000601:surgery*; D008297:Male; D009077:Mucins / Q000378:metabolism; D010743:Phospholipids / Q000378:metabolism; D011184:Postoperative Period; D012307:Risk Factors; D055502:Secondary Prevention
D001647:Bile Acids and Salts; D009077:Mucins; D010743:Phospholipids; D002784:Cholesterol; D001663:Bilirubin