Basic Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2020; 26(46): 7312-7324
Published online Dec 14, 2020. doi: 10.3748/wjg.v26.i46.7312
Extrahepatic bile duct reconstruction in pigs with heterogenous animal-derived artificial bile ducts: A preliminary experience
Hao Shang, Jian-Ping Zeng, Si-Yuan Wang, Ying Xiao, Jiang-Hui Yang, Shao-Qing Yu, Xiang-Chen Liu, Nan Jiang, Xia-Li Shi, Shuo Jin
Hao Shang, Jian-Ping Zeng, Si-Yuan Wang, Shao-Qing Yu, Xiang-Chen Liu, Shuo Jin, Department of Hepatopancreatobiliary Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102200, China
Ying Xiao, Jiang-Hui Yang, Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102200, China
Nan Jiang, Institute for Precision Medicine Tsinghua University, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
Xia-Li Shi, Department of Anesthesiology and Operation, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Author contributions: Shang H and Zeng JP contributed equally to this work; Shang H, Zeng JP and Jin S designed the study; Shang H, Zeng JP, Yu SQ, Liu XC, Jiang N, Shi XL and Jin S carried out the study; Xiao Y and Yang JH performed the pathological analysis; Zeng JP and Wang SY collected and analyzed the data; Shang H and Jin S wrote the manuscript.
Supported by the Beijing Natural Science Foundation, No. 7194338.
Institutional review board statement: The study was reviewed and approved by the Local Ethics Committee of Beijing Tsinghua Changgung Hospital (Beijing, China) (permit No. 2016-KY-GJ-10).
Institutional animal care and use committee statement: All the experiments were conducted in compliance with the NIH Guidelines and the Animal Research Protocol of Experimental Animal Center of Beijing Tsinghua Changgung Hospital.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this work.
Data sharing statement: No additional data are available.
ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Shuo Jin, MD, PhD, Attending Doctor, Department of Hepatopancreatobiliary Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing 102200, China. jsa01263@btch.edu.cn
Received: August 27, 2020
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
Abstract
BACKGROUND

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.

AIM

To evaluate the long-term feasibility of a novel heterogenous ada-BD for treating extrahepatic BDI in pigs.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Bile duct injury, Animal-derived artificial bile duct, Heterogenous ureteral graft, Nonimmunogenic, Bile duct reconstruction, Common bile duct

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.