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Cai YL, Nan F, Tang GT, Ma Y, Ren Y, Xiong XZ, Zhou RX, Li FY, Cheng NS, Jiang X. Fabrication of 3D printed PCL/PEG artificial bile ducts as supportive scaffolds to promote regeneration of extrahepatic bile ducts in a canine biliary defect model. J Mater Chem B 2023; 11:9443-9458. [PMID: 37727116 DOI: 10.1039/d3tb01250f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
In this study, a 3D porous poly(ε-caprolactone)/polyethylene glycol (PCL/PEG) composite artificial tubular bile duct was fabricated for extrahepatic bile duct regeneration. PCL/PEG composite scaffolds were fabricated by 3D printing, and the molecular structure, mechanical properties, thermal properties, morphology, and in vitro biocompatibility were characterized for further application as artificial bile ducts. A bile duct defect model was established in beagle dogs for in vivo implantation. The results demonstrated that the implanted PE1 ABD, serving as a supportive scaffold, effectively stimulated the regeneration of a new bile duct comprising CK19-positive and CK7-positive epithelial cells within 30 days. Remarkably, after 8 months, the newly formed bile duct exhibited an epithelial layer resembling the normal structure. Furthermore, the study revealed collagen deposition, biliary muscular formation, and the involvement of microvessels and fibroblasts in the regenerative process. In contrast, the anastomotic area without ABD implantation displayed only partial restoration of the epithelial layer, accompanied by fibroblast proliferation and subsequent bile duct fibrosis. These findings underscore the limited inherent repair capacity of the bile duct and underscore the beneficial role of the PE1 ABD artificial tubular bile duct in promoting biliary regeneration.
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Affiliation(s)
- Yu-Long Cai
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Fang Nan
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Guo-Tao Tang
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Yuan Ma
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Yi Ren
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Xian-Ze Xiong
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Rong-Xing Zhou
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Fu-Yu Li
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Nan-Sheng Cheng
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Xia Jiang
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
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Miyazawa M, Aikawa M, Takashima J, Kobayashi H, Ohnishi S, Ikada Y. Pitfalls and promises of bile duct alternatives: A narrative review. World J Gastroenterol 2022; 28:5707-5722. [PMID: 36338889 PMCID: PMC9627420 DOI: 10.3748/wjg.v28.i39.5707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/18/2022] [Accepted: 09/23/2022] [Indexed: 02/06/2023] Open
Abstract
Biliodigestive anastomosis between the extrahepatic bile duct and the intestine for bile duct disease is a gastrointestinal reconstruction that abolishes duodenal papilla function and frequently causes retrograde cholangitis. This chronic inflammation can cause liver dysfunction, liver abscess, and even bile duct cancer. Although research has been conducted for over 100 years to directly repair bile duct defects with alternatives, no bile duct substitute (BDS) has been developed. This narrative review confirms our understanding of why bile duct alternatives have not been developed and explains the clinical applicability of BDSs in the near future. We searched the PubMed electronic database to identify studies conducted to develop BDSs until December 2021 and identified studies in English. Two independent reviewers reviewed studies on large animals with 8 or more cases. Four types of BDSs prevail: Autologous tissue, non-bioabsorbable material, bioabsorbable material, and others (decellularized tissue, 3D-printed structures, etc.). In most studies, BDSs failed due to obstruction of the lumen or stenosis of the anastomosis with the native bile duct. BDS has not been developed primarily because control of bile duct wound healing and regeneration has not been elucidated. A BDS expected to be clinically applied in the near future incorporates a bioabsorbable material that allows for regeneration of the bile duct outside the BDS.
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Affiliation(s)
- Mitsuo Miyazawa
- Department of Surgery, Teikyo University Mizonokuch Hospital, Kanagawa 213-8507, Japan
| | - Masayasu Aikawa
- Department of Surgery, Saitama Medical University International Medical Center, Saitama 350-1298, Japan
| | - Junpei Takashima
- Department of Surgery, Teikyo University Mizonokuch Hospital, Kanagawa 213-8507, Japan
| | - Hirotoshi Kobayashi
- Department of Surgery, Teikyo University Mizonokuch Hospital, Kanagawa 213-8507, Japan
| | - Shunsuke Ohnishi
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Yoshito Ikada
- Department of Bioenvironmental Medicine, Nara Medical University, Nara 634-8521, Japan
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Nakashima S, Nakamura T, Miyagawa K, Yoshikawa T, Kin S, Kuriu Y, Nakase Y, Sakakura C, Otsuji E, Hagiwara A, Yamagishi H. In Situ Tissue Engineering of the Bile Duct Using Polypropylene Mesh-Collagen Tubes. Int J Artif Organs 2018; 30:75-85. [PMID: 17295195 DOI: 10.1177/039139880703000110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Multiple attempts have been made to replace biliary defects with a variety of materials. Recently, successful biliary reconstruction using the Gore-Tex vascular graft has been reported experimentally and clinically We designed a new artificial bile duct consisting of collagen sponge and polypropylene mesh. We presently evaluated the feasibility of using this prosthesis as a scaffold for bile duct tissue regeneration in a canine model. Our prosthesis, a sponge made from porcine dermal collagen, is reinforced with a polypropylene mesh cylinder. We used the prosthesis to reconstruct the middle portion of the common bile duct in seven beagle dogs to evaluate its efficacy. While one dog died of biliary stricture 8 months after operation, six survived without problems to scheduled time points for tissue evaluation at 1 to 12 months. All prostheses had become completely incorporated into the host. A confluent epithelial lining was observed within 3 months. In cholangiograms the prosthesis displayed long-term patency in the six dogs and provided satisfactory bile drainage for up to 12 months. Our graft thus shows promise for repair of biliary defects and should lead to development of a new treatment for biliary reconstruction.
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Affiliation(s)
- S Nakashima
- Department of Surgery and Regenerative Medicine, Division of Surgery and Physiology of Digestive System, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Justin AW, Saeb-Parsy K, Markaki AE, Vallier L, Sampaziotis F. Advances in the generation of bioengineered bile ducts. Biochim Biophys Acta Mol Basis Dis 2017; 1864:1532-1538. [PMID: 29097260 DOI: 10.1016/j.bbadis.2017.10.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 12/17/2022]
Abstract
The generation of bioengineered biliary tissue could contribute to the management of some of the most impactful cholangiopathies associated with liver transplantation, such as biliary atresia or ischemic cholangiopathy. Recent advances in tissue engineering and in vitro cholangiocyte culture have made the achievement of this goal possible. Here we provide an overview of these developments and review the progress towards the generation and transplantation of bioengineered bile ducts. This article is part of a Special Issue entitled: Cholangiocytes in Health and Diseaseedited by Jesus Banales, Marco Marzioni and Peter Jansen.
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Affiliation(s)
| | - Kourosh Saeb-Parsy
- Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Athina E Markaki
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Ludovic Vallier
- Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK; Wellcome Trust Sanger Institute, Hinxton, UK; Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fotios Sampaziotis
- Department of Surgery, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK; Wellcome Trust-Medical Research Council Stem Cell Institute, Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK; Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Buscemi S, Damiano G, Fazzotta S, Maffongelli A, Palumbo V, Ficarella S, Fiorica C, Cassata G, Licciardi M, Palumbo F, Gulotta L, Buscemi G, lo Monte A. Electrospun Polyhydroxyethyl-Aspartamide–Polylactic Acid Scaffold for Biliary Duct Repair: A Preliminary In Vivo Evaluation. Transplant Proc 2017; 49:711-715. [DOI: 10.1016/j.transproceed.2017.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Moazeni N, Semnani D, Rafeinia M, Hasani H, Naeimi M, Sadrjahani M. The effect of electrospinning parameters on the compliance behavior of electrospun polyurethane tube for artificial common bile duct. POLYMER SCIENCE SERIES A 2017. [DOI: 10.1134/s0965545x17010114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cheng Y, Xiong XZ, Zhou RX, Deng YL, Jin YW, Lu J, Li FY, Cheng NS. Repair of a common bile duct defect with a decellularized ureteral graft. World J Gastroenterol 2016; 22:10575-10583. [PMID: 28082809 PMCID: PMC5192268 DOI: 10.3748/wjg.v22.i48.10575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/04/2016] [Accepted: 11/13/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the feasibility of repairing a common bile duct defect with a decellularized ureteral graft in a porcine model.
METHODS Eighteen pigs were randomly divided into three groups. An approximately 1 cm segment of the common bile duct was excised from all the pigs. The defect was repaired using a 2 cm long decellularized ureteral graft over a T-tube (T-tube group, n = 6) or a silicone stent (stent group, n = 6). Six pigs underwent bile duct reconstruction with a graft alone (stentless group). The surviving animals were euthanized at 3 mo. Specimens of the common bile ducts were obtained for histological analysis.
RESULTS The animals in the T-tube and stent groups survived until sacrifice. The blood test results were normal in both groups. The histology results showed a biliary epithelial layer covering the neo-bile duct. In contrast, all the animals in the stentless group died due to biliary peritonitis and cholangitis within two months post-surgery. Neither biliary epithelial cells nor accessory glands were observed at the graft sites in the stentless group.
CONCLUSION Repair of a common bile duct defect with a decellularized ureteral graft appears to be feasible. A T-tube or intraluminal stent was necessary to reduce postoperative complications.
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Abstract
The purpose of this study is to introduce and evaluate a new technique of repairing bile ducts by the tubular gastric wall with a vascularized pedicle. Both the end-to-end bile duct repair and Roux-en-Y hepatoenterostomy have limitations in the treatment of benign bile duct strictures after cholecystectomy. There are no other good choices to manage these cases, especially the bile duct transection injuries or partly missing common bile duct or hepatic duct. Eleven patients with partly missing common bile ducts in the Chinese People's Liberation Army General Hospital between January 2007 and December 2012 were retrospectively analyzed. The study comprised 8 females and 3 males, whose age ranged from 29 to 56 years. All patients underwent successful bile duct repair. The time of operations ranged from 210 minutes to 240 minutes. The maximal blood loss was less than 220 ml. There was no perioperative mortality and no case of gastric fistula. Postoperative complications occurred in 3 patients, including wound infection, bile leakage, and erosive gastritis. All complications were cured by conservative treatment. The mean follow-up time was 42 months. One patient was classified as Terblanche's grade II and 10 patients were classified as Terblanche's grade I. The observations indicate that this technique is a feasible and effective choice to manage low level biliary stricture after cholecystectomy, especially suitable to repair bile duct transection injuries or partly missing common bile duct or hepatic duct.
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Li Q, Tao L, Chen B, Ren H, Hou X, Zhou S, Zhou J, Sun X, Dai J, Ding Y. Extrahepatic bile duct regeneration in pigs using collagen scaffolds loaded with human collagen-binding bFGF. Biomaterials 2012; 33:4298-308. [PMID: 22429981 DOI: 10.1016/j.biomaterials.2012.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 03/03/2012] [Indexed: 12/21/2022]
Abstract
Extrahepatic bile duct defects and their complications are benign lesions but with malignant outcomes. Extrahepatic bile duct regeneration at the injury site could be important for the repair. In our previous work, a human basic fibroblast growth factor (bFGF) fused with a collagen-binding domain (CBD) was produced to activate the collagen membrane to obtain targeted tissue regeneration. This collagen/growth factor functional biomaterial could promote the regeneration of skin, bladder and full-thickness abdominal wall by accelerating vascularization and cellularization of autologous tissues. We speculate that the functional biomaterial could also provide the repairing effect on extrahepatic bile duct injuries. Using a pig extrahepatic bile duct injury model, we found that the collagen/CBD-bFGF composite biomaterial could significantly promote the extrahepatic bile duct regeneration at the injury site without causing structure deformation or hepatic dysfunction during both short- and long-time observations.
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Affiliation(s)
- Qiang Li
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
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An extrahepatic bile duct grafting using a bioabsorbable polymer tube. J Gastrointest Surg 2012; 16:529-34. [PMID: 22223111 DOI: 10.1007/s11605-011-1801-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 12/14/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Thus far, no ideal substitutions have been developed for completely replacing the extrahepatic bile duct (EHBD). METHODS We used a bioabsorbable polymer tube (BAPT) for the complete reconstruction of an EHBD in pigs. A 2-cm-long EHBD was resected from the duodenal side, and a 4-cm-long BAPT graft was implanted at that site. The animals were re-laparotomized at 1 or 4 months after the grafting; subsequently, gross, histological, and blood chemical studies were performed. RESULTS At 1 month after grafting, tubular structure was observed in all resected specimens, and the lumen of the graft site had remnants of degraded BAPT. Gross examination at 4 months after grafting revealed that the BAPT had been completely absorbed, and the graft site was indistinguishable from the native extrahepatic bile duct. The lengths of the graft region at 4 months were 70% of the replaced BAPT. Simultaneously performed histological examination revealed the growth of a neo-bile duct at the graft site, with an epithelium identical to that of the native bile duct. CONCLUSION The BAPT graft implanted in this study completely replaced the EHBD defect. Hence, BAPT has the potential for application as a novel treatment modality for hepatobiliary diseases.
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Helmy AA, Hamad MA, Aly AM, Sherif T, Hashem M, El-Sers DA, Semieka M. Novel technique for biliary reconstruction using an isolated gastric tube with a vascularized pedicle: a live animal experimental study and the first clinical case. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2011; 5:8. [PMID: 21985492 PMCID: PMC3198750 DOI: 10.1186/1750-1164-5-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 10/10/2011] [Indexed: 12/24/2022]
Abstract
Background Biliary tract reconstruction continues to be a challenging surgical problem. Multiple experimental attempts have been reported to reconstruct biliary defects with different materials and variable outcome. Our aim was to evaluate a new method for biliary reconstruction using an isolated pedicled gastric tube in a live animal trial and also to present the first clinical case. Methods Seven mongrel dogs underwent biliary reconstruction using gastric tube harvested, completely separated from the greater curvature, and based on a vascularized pedicle with the right gastroepiploic vessels. The tube was interposed between the common bile duct (CBD) and the duodenum. Postoperative mortality, morbidity, liver functions, gross and microscopic histological picture were assessed. The first clinical case was also presented where, in a patient with post-cholecystectomy biliary injury, an isolated pedicled gastric tube was interposed between the proximal and distal ends of the CBD. Results One dog did not recover from anesthesia and another one died postoperatively from septic peritonitis. Five dogs survived the procedure and showed uneventful course and no cholestasis. The mean anastomotic circumference was 4.8 mm (range 4-6) for CBD anastomosis and 6.2 mm (range 5-7) for duodenal anastomosis. Histologically, anastomotic sites showed good evidence of healing. In the first clinical case, the patient showed clinical and biochemical improvement. Endoscopic retrograde cholangiography was feasible and assured patent biliary anastomoses. Conclusion In mongrel dogs, biliary reconstruction using pedicled gastric tube interposition between CBD and duodenum is feasible with satisfactory clinical results, anastomotic circumference and histological evidence of healing. The technique is also feasible in human and seems to be promising.
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Affiliation(s)
- Ashraf A Helmy
- Department of General Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt.
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Schanaider A, Pannain VLN, Müller LCCM, Maya MCA. Expanded polytetrafluoroethylene in canine bile duct injury: a critical analysis. Acta Cir Bras 2011; 26:247-52. [DOI: 10.1590/s0102-86502011000400001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 03/15/2011] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: Analyze the morphological and structural outcomes of a patch of expanded polytetrafluoroethylene in the treatment of an iatrogenic injury of the common bile duct. METHODS: In Group 1 (Sham), 7 dogs underwent 3 laparotomies with intervals of 30 days between them. In Group 2, 10 dogs underwent transient common bile duct obstruction. After 30 days, this biliary occlusion was undone and a patch of expanded polytetrafluoroethylene replaced a fragment removed from the duct's wall. Thirty days after this last surgery, cholangiographic assessment of prosthesis patency and macro and microscopic evaluation of the biliary tract were performed. Daily clinical inspection completed the study outcomes. The Wilcoxon non-parametric test was used for statistical analysis. RESULTS: In all dogs enlargement of the biliary tree diameter was observed 30 and 60 days after the first surgical procedure. Partial adhesion of the patch to the common bile duct as a free luminal foreign body was found in 6 dogs. The prosthesis was completely integrated to surrounding tissue in the remaining four. CONCLUSION: Although a feasible option for the treatment of biliary duct iatrogenic lesions, the expanded polytetrafluoroethylene prosthesis must be used with caution considering the potential risks for complications.
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Miyazawa M, Aikawa M, Okada K, Toshimitsu Y, Okamoto K, Koyama I, Ikada Y. Regeneration of extrahepatic bile ducts by tissue engineering with a bioabsorbable polymer. J Artif Organs 2011; 15:26-31. [DOI: 10.1007/s10047-011-0590-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 07/04/2011] [Indexed: 12/29/2022]
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A novel treatment for bile duct injury with a tissue-engineered bioabsorbable polymer patch. Surgery 2010; 147:575-80. [DOI: 10.1016/j.surg.2009.10.049] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Accepted: 10/12/2009] [Indexed: 01/24/2023]
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15
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Nakashima S, Nakamura T, Han LH, Miyagawa K, Yoshikawa T, Sakakura C, Hagiwara A, Otsuji E. Experimental Biliary Reconstruction with an Artificial Bile Duct Using in situ Tissue Engineering Technique. Inflamm Regen 2007. [DOI: 10.2492/inflammregen.27.579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Gómez NA, Zapatier JA, Vargas PE. Re: "Small intestinal submucosa as a bioscaffold for biliary tract regeneration". Surgery 2004; 135:460. [PMID: 15041976 DOI: 10.1016/j.surg.2003.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Rosen M, Ponsky J, Petras R, Fanning A, Brody F, Duperier F. Small intestinal submucosa as a bioscaffold for biliary tract regeneration. Surgery 2002; 132:480-6. [PMID: 12324762 DOI: 10.1067/msy.2002.126505] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Porcine small intestinal submucosa (SIS) biograft is used as a bioscaffold for regeneration of a variety of tissues. To date, SIS has not been used as a biliary tract graft. The purpose of this study was to evaluate the feasibility of using SIS as a scaffold for bile duct tissue regeneration in a canine model. METHODS Fifteen, 25- to 35-kg mongrel dogs underwent midline laparotomy and exposure of the common bile duct. Nine dogs had a longitudinal choledochotomy and a 2- x 1-cm elliptical patch of 4-ply SIS placed using 6-0 polypropylene suture. Six dogs had the anterior two thirds of the bile duct resected and a 2- to 3-cm tubularized 4-ply SIS interposition graft placed. Dogs were killed at intervals ranging from 2 weeks to 5 months. Before killing, liver function tests (alkaline phosphatase [U/L] and total bilirubin [mg/dL]) were evaluated, cholangiograms were performed, and the bile duct was examined histologically. RESULTS Fourteen out of 15 dogs survived and were healthy at the time of killing. The one failure was a result of a bile leak in a patched animal. The SIS showed signs of incorporation with infiltration of native fibroblasts, blood vessels, and biliary mucosa within 2 weeks. Within 3 months the SIS graft was replaced with native collagen covered with a biliary epithelium. No changes occurred at 5-month follow-up. One animal with an interposition graft developed a stricture at the proximal anastomosis within 2 months. In the remaining dogs, liver enzymes were normal, and the caliber of the common bile duct remained normal. CONCLUSIONS SIS can be used for regeneration of bile duct tissue in a canine model. In 13 of 15 dogs SIS resulted in regeneration of canine common bile duct when used as a patch or as an interposition graft. The potential for the use of SIS as a patch for biliary stricturoplasty, or as an interposition graft for repair of complex biliary injuries is encouraging.
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Affiliation(s)
- Michael Rosen
- Department of General Surgery, Cleveland Clinic Foundation, and Ameripath Corporation, Ohio 44195, USA
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Abstract
Non-surgical trauma to the extrahepatic biliary tract is uncommon and encountered only rarely by surgeons outside specialist hepatobiliary centres. Such injury often results in significant morbidity and mortality. This review outlines the incidence, classification, mechanisms of injury, presentation, diagnostic techniques and management options. Depending on the type of biliary injury identified, an optimal method of repair is suggested. Recommendations are made for surgeons who encounter this type of injury and do not have the appropriate expertise for definitive management.
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Affiliation(s)
- R W Parks
- Department of Surgery, Queen's University of Belfast, UK
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Flati G, Flati D, Porowska B, Rossi G, Francavilla S, Santoro E, Carboni M. Circumferential choledochoplasties with autologous venous and arterial grafts. Microsurgery 1993; 14:628-33. [PMID: 8289650 DOI: 10.1002/micr.1920140917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Circumferential choledochoplasties with vascular grafts have rarely been attempted either experimentally or in clinical practice. In this study, choledochoplasties using autologous venous and arterial grafts were performed in rats. Sixty-four rats were randomly selected into five treatment groups: A) venous interpositional graft replacement of a choledochus gap without a stent; B) venous graft with prolene stent; C) venous graft with polyethylene stent; D) arterial graft; E) a control group with simple resection between ligatures in the choledochus. The operative mortality in treatment groups B, C, D, and E, was 0, and 13% in group A. At 12 weeks follow-up, all the rats in group E had died, whereas, 52.2% (P < .05) of the rats in group A, 30% of the rats in group B, 57% of the rats in group C, and 92.8% of the rats in group D survived treatment. Surviving animals were sacrificed at 3 months for further examination. The morphology and caliber of the common bile duct of these rats were normal in 25% of the rats in group A, 33% of the rats in group B, 25% of the rats in group C, and 84.6% of the rats in group D. Proximal dilations were found in the rats presenting with abnormal morphology. The dilations were less marked in the group treated by arterial choledochoplasties. Laboratory and clinical cholestatic parameters were within normal ranges in the presence of common bile duct dilations less than four times the normal duct caliber.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Flati
- Surgical Pathology, V, University of Rome, La Sapienza, Italy
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Scudamore CH, Becker CD, Fache JS, Bianco R, Shackleton CR, Burhenne HJ, Owen DA, Schechter MT, Seccombe D. Human amnion as a bioprosthesis for bile duct reconstruction in the pig. Am J Surg 1988; 155:635-40. [PMID: 3369617 DOI: 10.1016/s0002-9610(88)80132-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Despite technical advances in management, the complication of late stricture formation and biliary sepsis still occur in bile duct reconstruction. In an attempt to avoid bilioenteric anastomosis, which bypasses the biliary sphincter mechanism, various biologic and artificial materials have been employed clinically and experimentally to replace the damaged bile duct. No satisfactory biliary replacement material has yet been found. In the experimental model of bile duct stricture that has been presented, human amnion bile duct injuries mimicking those seen in clinical practice were repaired using human amnion as a free graft. Noncircumferential duct loss appeared to be satisfactorily repaired using amnion, and the amnion repair was found to be as good as or superior to plastic repair; however, circumferential duct loss was not adequately repaired with the amnion graft.
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Affiliation(s)
- C H Scudamore
- Department of Surgery, University of British Columbia, Vancouver, Canada
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Bengtsson HJ, Broomé AE, Rimér U. Repair of bile duct defect with full-thickness vascularized jejunal patch. World J Surg 1986; 10:510-5. [PMID: 3727612 DOI: 10.1007/bf01655323] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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