Letter to the Editor
Copyright ©The Author(s) 2023.
World J Gastroenterol. Aug 14, 2023; 29(30): 4701-4705
Published online Aug 14, 2023. doi: 10.3748/wjg.v29.i30.4701
Table 1 Differences in understanding of the clinical evidences between a surgeon and a physiologist
Clinical evidences
Understanding of a surgeon
Understanding of a physiologist
There are many negative results of the use of materials for bile duct repairMaterials associated with complications are not suitable for clinical practiceThe causes of failure are what we need to determine. Can we cluster these causes to understand the underlying mechanisms? If we only consider successful cases, we will commit survival bias and be unable to determine the reasons for successful outcomes
Bile duct epithelialization never exceed the following limits: About 3 cm long and growth not more than 1-2 mm per weekWe must avoid implanting grafts (autografts) longer than 3 cm. This is an interesting fact. My experience supports these values, so I am aware of the potential outcomes that may be achieved after a surgical procedureThe presence of stable values indicates the conservatism of the underlying regenerative mechanisms, which are not dependent on the surgeon’s skills or the quality of the materials
The normal human bile is not sterile and contains both living cholangiocytes and normal biliary microbiotaThese are interesting facts, but we still lack the necessary tools to support endogenous regeneration in routine clinical practice. The application of cells remains unprovenThe presence of living cells in bile may support the existence of unknown ways for the migration of bile duct cells. These methods need to be discovered and applied for bile duct regeneration