Pitfalls and promises of bile duct alternatives: A narrative review

Table 2 Bile duct substitute using non-bioabsorbable material

Ref.	Journal	Substitute (n)	Stent	Animal type (n)	Size of BDS (cm)	Method of reconstruction of bile duct by BDS (n)	Observation period after implantation	Localization of regenerated bile duct	Causes of stenosis	Note (planned sacrificial death and epithelialization)
Dunphy and Stephens[19], 1962	Ann Surg	Teflon (8)	(-)	Dog (4), goat (4)	Ring (1.0)	CBC (8)	Maximum 7 wk	BDS outside	Narrowing of the anastomosis with the native bile duct; narrowing of the lumen of BDS	In all cases, the hepatobiliary enzyme levels increased, and no survivors were observed for more than 7 wk after transplantation
Bergan et al[20], 1962	Arch Surg	Vascularized polyvinyl sponge (21)	(-)	Dog (21)	Ring (0.5)	CBC (21)	Maximum 14 mo	BDS outside	Narrowing of the anastomosis with the native bile duct; narrowing of the lumen of BDS	Four out of 21 dogs survived for > 60 d after transplantation, and four of them had stenosis of BDS
Sherman et al[21], 1963	Ann Surg	Acrylamide with Dacron (33)	(-)	Dog (33)	Ring (1.5-3.5)	CBC (33)	Maximum 31 mo	BDS outside	Narrowing of the anastomosis with the native bile duct; narrowing of the lumen of BDS	Twenty-six out of 33 dogs died within 3 mo. In all cases, fibrotic thickening around the BDS and severe scar contraction had occurred at the site of anastomosis
Mendelowitz et al[22], 1982	Am J Surg	Gore-Tex (6), dacron (2)	(-)	Dog (8)	Ring (2.0-3.0), patch (2.0 cm × 1.0 cm)	Patch (Gore-Tex) (2), CBJ (Gore-Tex) (2), CBC (Gore-Tex) (1), CBC (Dacron) (2), GBJ (Gore-Tex) (1)	Maximum 40 d	BDS outside	Narrowing of the anastomosis with the native bile duct; narrowing of the lumen of BDS	In all cases, a bile plug was found in the lumen of the BDS, and a high degree of fibrotic thickening was found around the site of anastomosis
Gómez et al[23], 2002	J Gastrointest Surg	Gore-Tex (12)	(-)	Dog (12)	Ring (2.0-3.0)	CBC (12)	Maximum 3 mo	BDS outside	Narrowing of the lumen of BDS	Eleven out of 12 dogs were intentionally killed, but severe fibrotic thickening was observed around the BDS

BDS: Bile duct substitute; CBC: Common bile duct to bile duct substitute to common bile duct; CBJ: Common bile duct to bile duct substitute to jejunum; GBJ: Gallbladder to bile duct substitute to jejunum.