Influence of biliary anastomosis on recovery from secondary biliary cirrhosis.
OBJECTIVE
The influence of choledochoduodenostomy and choledochojejunostomy on the repair of hepatic lesions secondary to biliary obstruction is not well known. The aim of the present study was to compare the effects of choledochoduodenostomy and choledochojejunostomy on the recovery of these lesions in rats with biliary obstruction.


METHODS
Rats subjected to 4 weeks of biliary obstruction underwent choledochoduodenostomy (n=10) or choledochojejunostomy (n=10). The following variables were measured: total bilirubin, alkaline phosphatase, aminotransferases, and albumin. Hepatic mitochondrial energy metabolism was evaluated by calculating the respiratory control ratio and the oxidative phosphorylation index. Hepatic morphometry was used to estimate the mass of the hepatocytes, bile ducts, and fibrosis, as well as the hepatic stellate cell count.


RESULTS
After choledochoduodenostomy and choledochojejunostomy, there was a regression in cholestasis and a reduction in the oxidative phosphorylation index. However, the total bilirubin, alkaline phosphatase, albumin, and respiratory control ratio values improved only after choledochojejunostomy. The mass of the liver, spleen, and fibrosis was reduced after both choledochoduodenostomy and choledochojejunostomy, but the number of hepatic stellate cells increased. After choledochojejunostomy, the hepatic mass recovered completely, and the spleen mass was significantly reduced compared with that after choledochoduodenostomy. After both choledochoduodenostomy and choledochojejunostomy, enterobiliary reflux, biliary contamination, and an exacerbation in hepatic inflammation developed.


CONCLUSIONS
Choledochojejunostomy was more effective than choledochoduodenostomy, but both techniques induced enterobiliary reflux and biliary contamination, which may explain the maintenance of hepatic alterations, especially after choledochoduodenostomy.
Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
José Sebastião
JS
dos Santos
Rafael
R
Kemp
Murilo Ferreira
MF
de Andrade
Luciano
L
Neder
D000469:Alkaline Phosphatase / Q000097:blood; D000714:Anastomosis, Surgical; D000818:Animals; D001663:Bilirubin / Q000097:blood; D002768:Choledochostomy / Q000379:methods*; D002779:Cholestasis / Q000601:surgery*; D008099:Liver / Q000033:anatomy & histology / Q000166:cytology / Q000201:enzymology; D008103:Liver Cirrhosis / Q000201:enzymology / Q000473:pathology / Q000601:surgery; D008105:Liver Cirrhosis, Biliary / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008297:Male; D008930:Mitochondria, Liver / Q000378:metabolism / Q000473:pathology; D009929:Organ Size; D051381:Rats; D017208:Rats, Wistar; D013154:Spleen / Q000033:anatomy & histology; D000637:Transaminases / Q000097:blood; D016896:Treatment Outcome
D000637:Transaminases; D000469:Alkaline Phosphatase; D001663:Bilirubin