title: Novel reconstruction of the extrahepatic biliary tree with a biosynthetic absorbable graft.
abstract: OBJECTIVE
  The reference standard technique for the reconstruction of the extrahepatic biliary tree is Roux-en-Y hepaticojejunostomy. This procedure is not without complications and may not be feasible in some patients. This project sought to evaluate a novel approach for repairing common bile duct injuries with a biosynthetic graft. This allows for the reconstruction of the anatomy without necessitating an intestinal bypass.
  
  
  METHODS
  Study subjects were 11 mongrel hounds. Utilizing an open approach, the common bile duct was transected in each animal. A 1-cm graft of a synthetic bioabsorbable prosthesis was interposed over a 5-Fr pancreatic stent and sewn in place as an interposition tube graft with absorbable sutures. Intraoperative cholangiograms and monthly liver function tests were completed. Animals were killed at 6, 7, 8, 10 and 12 months.
  
  
  RESULTS
  The first five animals were killed early in the process of protocol development. One animal developed obstructive symptoms and was killed on postoperative day 14. The next five animals were longterm survivors without evidence of clinically significant graft stenosis. Mean alkaline phosphatase and total bilirubin were normal, at 140 U/l and 0.2 mg/dl, respectively. Histology showed the complete replacement of the graft with native tissue at 6 months.
  
  
  CONCLUSIONS
  Biliary reconstruction using a synthetic bioabsorbable prosthetic as an interposition tube graft is feasible based on initial results.
authors.affiliation: Department of Surgery Department of Pathology, Ohio State University School of Medicine and Public Health, Columbus, OH, USA. peter.nau@osumc.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Nau
authors.forename: James
authors.initials: J
authors.lastname: Liu
authors.forename: E Christopher
authors.initials: EC
authors.lastname: Ellison
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Hazey
authors.forename: Matthew
authors.initials: M
authors.lastname: Henn
authors.forename: Peter
authors.initials: P
authors.lastname: Muscarella
authors.forename: Vimal K
authors.initials: VK
authors.lastname: Narula
authors.forename: W Scott
authors.initials: WS
authors.lastname: Melvin
mesh_terms: D020341:Absorbable Implants; D000818:Animals; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004285:Dogs; D005240:Feasibility Studies; D023421:Models, Animal; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D011859:Radiography; D015607:Stents; D013536:Suture Techniques; D013997:Time Factors