title: Influence of biliary drainage on the repair of hepatic lesions in biliary fibrosis.
abstract: BACKGROUND
  Bilioduodenal (BD) and biliojejunal (BJ) derivation induce enterobiliary reflux and bile stasis. Decompression of the excluded loop of the Roux-en-Y (BJD) was proposed to minimize these effects. The aim of this study was to compare the influence of these three modalities of biliary bypass on hepatic lesion repair in rats with secondary biliary fibrosis.
  
  
  METHODS
  Rats with 15 d of biliary obstruction underwent BD, BJ, and BJD drainage and were compared with a group submitted to simulated operation (SO) and biliary obstruction (CBO). The serum values of total and fractional bilirubin, alkaline phosphatase (ALP), and aminotransferases (AST and ALT), as well as hepatobiliointestinal excretion determined with (99m)Tc-Disida, were used for comparison. In addition, we used morphometric analyses to estimate the mass of the hepatocytes, bile ducts, and liver fibrosis. We also counted hepatic stellate cells (SC).
  
  
  RESULTS
  For each of the three modalities of biliary drainage, there were significant reductions in bilirubin, AST, ALP, and the number of SCs. The recovery of the estimated mass of all histologic components occurred only after BJ and BJD; in the BD group, the estimated hepatocyte mass was reduced compared with the SO group. The residual hepatic radioactivity of (99m)Tc-Disida was greater in the BJD group than in the SO group.
  
  
  CONCLUSIONS
  The interposition of the jejunal loop between the biliary tree and the intestine may slow hepatobiliary clearance of radioactivity, even though it provides the resolution of cholestasis and is effective in recovering from hepatic lesions.
authors.affiliation: Department of Surgery and Anatomy, Division of Digestive Surgery, University of São Paulo, at the Ribeirão Preto School of Medicine, Brazil. rafaelkemp@terra.com.br
authors.forename: Rafael
authors.initials: R
authors.lastname: Kemp
authors.forename: Whemberton Martins
authors.initials: WM
authors.lastname: de Araújo
authors.forename: Adelson Antonio
authors.initials: AA
authors.lastname: de Castro
authors.forename: José Celso
authors.initials: JC
authors.lastname: Ardengh
authors.forename: Luciano
authors.initials: L
authors.lastname: Neder
authors.forename: José Sebastião
authors.initials: JS
authors.lastname: dos Santos
mesh_terms: D000469:Alkaline Phosphatase / Q000378:metabolism; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D000818:Animals; D001652:Bile Ducts / Q000601:surgery*; D002779:Cholestasis / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004195:Disease Models, Animal; D004386:Duodenum / Q000601:surgery; D055166:Hepatic Stellate Cells / Q000473:pathology; D007583:Jejunum / Q000601:surgery; D008099:Liver / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D008103:Liver Cirrhosis / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008297:Male; D051381:Rats; D017208:Rats, Wistar; D000637:Transaminases / Q000378:metabolism
chemical_list: D000637:Transaminases; D000469:Alkaline Phosphatase