Published online Dec 14, 2020. doi: 10.3748/wjg.v26.i46.7312
Peer-review started: August 27, 2020
First decision: September 30, 2020
Revised: October 6, 2020
Accepted: November 2, 2020
Article in press: November 2, 2020
Published online: December 14, 2020
Extrahepatic biliary duct injury (BDI) remains a complicated issue for surgeons. Although several approaches have been explored to address this problem, the high incidence of complications affects postoperative recovery. As a nonimmunogenic scaffold, an animal-derived artificial bile duct (ada-BD) could replace the defect, providing good physiological conditions for the regeneration of autologous bile duct structures without changing the original anatomical and physiologic conditions.
To evaluate the long-term feasibility of a novel heterogenous ada-BD for treating extrahepatic BDI in pigs.
Eight pigs were randomly divided into two groups in the study. The animal injury model was developed with an approximately 2 cm segmental defect of various parts of the common bile duct (CBD) for all pigs. A 2 cm long novel heterogenous animal-derived bile duct was used to repair this segmental defect (group A, ada-BD-to-duodenum anastomosis to repair the distal CBD defect; group B, ada-BD-to-CBD anastomosis to repair the intermedial CBD defect). The endpoint for observation was 6 mo (group A) and 12 mo (group B) after the operation. Liver function was regularly tested. Animals were euthanized at the above endpoints. Histological analysis was carried out to assess the efficacy of the repair.
The median operative time was 2.45 h (2-3 h), with a median anastomosis time of 60.5 min (55-73 min). All experimental animals survived until the endpoints for observation. The liver function was almost regular. Histologic analysis indicated a marked biliary epithelial layer covering the neo-bile duct and regeneration of the submucosal connective tissue and smooth muscle without significant signs of immune rejection. In comparison, the submucosal connective tissue was more regular and thicker in group B than in group A, and there was superior integrity of the regeneration of the biliary epithelial layer. Despite the advantages of the regeneration of the bile duct smooth muscle observed in group A, the effect on the patency of the ada-BD grafts in group B was not confirmed by macroscopic assessment and cholangiography.
This approach appears to be feasible for repairing a CBD defect with an ada-BD. A large sample study is needed to confirm the durability and safety of these preliminary results.
Core Tip: Extrahepatic biliary duct injury (BDI) remains a complicated issue for surgeons. Although several materials have been explored to repair extrahepatic biliary duct defects, the long-term efficacy is still unclear. This study evaluated the long-term feasibility of a novel heterogenous animal-derived artificial bile duct (ada-BD) for treating extrahepatic BDI in pigs. Eight pigs were randomly divided into two groups according to the various types of defects of the common bile duct. The results indicated that ada-BD safely served as a nonimmunogenic scaffold to replace the defect without changing the original anatomical and physiological conditions.