Application of a New Type of Sutureless Magnetic Biliary-Enteric Anastomosis Stent for One-Stage Reconstruction of the Biliary-Enteric Continuity After Acute Bile Duct Injury: An Experimental Study

• Published in: The Journal of surgical research 2008-08, Vol.148 (2), p.136-142
• Main Authors: Li, Jianhui, M.D, Lü, Yi, M.D., Ph.D, Qu, Bo, Ph.D, Zhang, Zhiyong, M.D, Liu, Chang, Ph.D, Shi, Yuan, Ph.D, Wang, Bo, Ph.D
• Format: Article
• Language: English
• Subjects: Anastomosis, Roux-en-Y - adverse effects; Anastomosis, Roux-en-Y - instrumentation; Anastomosis, Roux-en-Y - methods; Animals; bile duct injury; Bile Ducts - injuries; Biliary Tract - diagnostic imaging; Biliary Tract - pathology; Biliary Tract Surgical Procedures - adverse effects; Biliary Tract Surgical Procedures - instrumentation; Biliary Tract Surgical Procedures - methods; Biological and medical sciences; Cholangiography; cholangiojejunostomy; Disease Models, Animal; Dogs; General aspects; Jejunostomy - adverse effects; Jejunostomy - instrumentation; Jejunostomy - methods; Jejunum - surgery; magnetic; Magnetics; Medical sciences; Peritonitis - pathology; Peritonitis - surgery; reconstruction; Stents; Surgery
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2007.09.014

Background The bile duct cannot be repaired or reconstructed in one stage after 24 h of bile duct injury due to significant inflammation. Even if the bile duct can be repaired, anastomosis is difficult because of the extremely technical nature of the procedure. The traditional method of anastomosis utilizes screw thread. This would increase the inflammatory response, delay anastomotic healing, and lead to the increase in the failure rate. To reconstruct the biliary-enteric continuity under the circumstance of severe inflammation after bile duct injury, we invented a new type of anastomotic apparatus (sutureless magnetic stent) for cholangiojejunostomy. The objective of this study was to evaluate the effect of a new type of sutureless magnetic biliary-enteric anastomosis stent, which was used to reconstruct the biliary-enteric continuity in one stage. The reconstruction was conducted under the circumstance of severe inflammation after acute bile duct injury in dogs. Methods We used a model of acute bile duct injury and bile peritonitis in dogs. The sutureless magnetic biliary-enteric anastomosis stents was used to reconstruct the biliary-enteric continuity in one stage under the circumstance of a bile duct with severe inflammation. The effect of stents was observed. Cholangiography and anastomotic histology were examined at 1 mo and compared with traditional manual anastomosis. Results Anastomotic stents were used to reconstruct the biliary-enteric continuity in one stage in dogs. No anastomotic leak or infection occurred. Cholangiography showed that the anastomosis was unobstructed. Histological examinations showed that the anastomosis healed well, the inflammatory reaction was small, and collagen fibers lined up in order. There was high incidence of bile leakage in the conventional suture group. Cholangiography showed that anastomotic stenosis was high. Histological examination showed that there was more extensive inflammation around the anastomosis and the collagen fibers were disorganized. Conclusion It was safe and feasible to use the new type of anastomosis stent to reconstruct the biliary-enteric continuity in one stage under the circumstance of severe bile duct inflammation after bile duct injury in dogs.