Basic Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2016; 22(48): 10575-10583
Published online Dec 28, 2016. doi: 10.3748/wjg.v22.i48.10575
Repair of a common bile duct defect with a decellularized ureteral graft
Yao Cheng, Xian-Ze Xiong, Rong-Xing Zhou, Yi-Lei Deng, Yan-Wen Jin, Jiong Lu, Fu-Yu Li, Nan-Sheng Cheng
Yao Cheng, Xian-Ze Xiong, Rong-Xing Zhou, Yi-Lei Deng, Yan-Wen Jin, Jiong Lu, Fu-Yu Li, Nan-Sheng Cheng, Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Cheng Y and Xiong XZ contributed equally to this work; Cheng Y and Cheng NS designed the study; Zhou RX, Deng YL and Jin YW carried out the study; Xiong XZ and Lu J collected and analyzed the data; Cheng Y and Li FY wrote the paper.
Supported by National Natural Science Foundation of China, No. 30972923.
Institutional review board statement: The study was reviewed and approved by the Local Ethics Committee of West China Hospital (Sichuan, China).
Institutional animal care and use committee statement: All of the procedures were performed strictly according to the recommendations in the Guide for the Care and Use of Laboratory Animals of the National Institutes of Health. Appropriate measures were taken to minimize the animals’ pain and discomfort.
Conflict-of-interest statement: We declare that we have no financial or personal relationships with other people or organizations that could inappropriately influence our work.
Data sharing statement: The technical appendix, statistical code and dataset are available from the corresponding author at nanshengcheng@gmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nan-Sheng Cheng, MD, Professor, Department of Bile Duct Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. nanshengcheng@gmail.com
Telephone: +86-18980601366
Received: August 26, 2016
Peer-review started: August 29, 2016
First decision: September 20, 2016
Revised: October 4, 2016
Accepted: November 12, 2016
Article in press: November 22, 2016
Published online: December 28, 2016
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.

Keywords: Decellularization, Stent, Bile duct injury, Biliary reconstruction, Ureteral graft

Core tip: A common bile duct defect is a challenge for hepatobiliary surgeons. A decellularized ureteral graft was introduced in this experimental study to repair a common bile duct defect. If the biliary reconstruction was performed with a T-tube or stent insertion into the ureteral graft, all animals survived with normal liver function. The histology results showed a biliary epithelial layer regeneration over the graft. Thus, repair of a common bile duct defect with a decellularized ureteral graft appears to be feasible. In addition, a T-tube or stent was found to be necessary to reduce postoperative complications in this study.