Pitfalls and promises of bile duct alternatives: A narrative review

Figure 3 Bile duct substitutes using bioabsorbable material (synthetic polymer with short absorption period). A: A bile duct substitute (BDS) using bioabsorbable material is implanted to bypass the extrahepatic bile duct (3 cm in size). Three weeks post-BDS implantation; B: White cell clusters are observed on the outside of the BDS; C: A vulnerable BDS is observed from the duodenal side; D: Dark purple connective tissue is noted on the outside of the BDS; E: At 6 mo after BDS implantation, the neo-bile duct is macroscopically similar to the natural common bile duct have been regenerated (arrow); F: Cholangiography (6 mo after BDS implantation). The BDS implant and anastomotic site become unknown, and the contrast medium flows smoothly into the duodenum (white arrows).