Preventive Effect of Biodegradable Stents On Biliary Stricture And Fibrosis After Biliary Anastomosis In A Porcine Model

Abstract The aim of this animal study was to evaluate the preventive effect of novel biodegradable stents (BS) on biliary stricture and fibrosis after duct-to-duct (DD) biliary anastomosis. Ten mini-pigs were allocated to the control group (n = 5) and or the stent group (n = 5). The common bile duct was exposed through surgical laparotomy, and then resected transversely. In the stent group, a 4 mm or 6 mm polydioxanone/magnesium sheath core BS was inserted according to the width of the bile duct, followed by DD biliary anastomosis. In the control group, DD biliary anastomosis was performed without BS insertion. In the stent group, stents were observed without deformity for up to four weeks in all animals. Eight weeks later, histopathologic examination revealed that the common bile duct of the anastomosis site was relatively narrower in circumference in the control group compared to the stent group. The degree of fibrosis in the control group was more marked than in the stent group (3.84 mm vs. 0.68 mm, respectively, p < 0.05). Our study showed that novel BS maintained their original shape and radial force for an adequate time and then disappeared without adverse events.

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Laparoscopic Primary Closure of Common Bile Duct Combined with Percutaneous Cholangiographic Drainage for Treating Choledocholithiasis

The American Surgeon ◽

10.1177/000313481007600521 ◽

2010 ◽

Vol 76 (5) ◽

pp. 517-521 ◽

Cited By ~ 2

Author(s):

Shing-Moo Huang ◽

Chung-Chin Yao ◽

Ya-Wen Cheng ◽

Ling-Yun Chen ◽

Huichin Pan ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Primary Closure ◽

Operation Time ◽

Tube Placement ◽

Control Group ◽

Study Group ◽

T Tube ◽

Cbd Stones ◽

The Common

The aim of this study was to compare the efficacy and safety of laparoscopic primary closure of the common bile duct (CBD) combined with percutaneous transhepatic cholangiographic drainage (PTCD) and laparoscopic choledocholithotomy with T-tube placement for the treatment of CBD stones. Between January 1991 and July 2002, 50 patients with choledocholithiasis and a CBD diameter larger than or equal to 1 cm underwent laparoscopic CBD explorations. The study group consisted of 10 patients undergoing laparoscopic primary closure of the CBD combined with PTCD. The control group consisted of 40 patients undergoing laparoscopic choledocholithotomy with T-tube placement. Parameters were compared statistically. The study group showed higher female/male ratio (6/4 vs 8/32, P = 0.02), less stone numbers (1.90 ± 0.88 vs 3.40 ± 1.65, P = 0.0078), shorter operation time (138 ± 37 minutes vs 191 ± 75 minutes, P = 0.014), and shorter postoperative stays (7 ± 3 days vs 10 ± 3 days, P = 0.0013). It seems that laparoscopic primary closure of the CBD combined with PTCD can shorten the operation time and postoperative stays as compared with laparoscopic choledocholithotomy with T-tube placement for the treatment of CBD stones.

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Possible Protective Effect of Onion Supplementation on Hepatic Functional and Structural Alterations Induced by Cholestasis

QJM ◽

10.1093/qjmed/hcaa065.003 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A A Mohamed ◽

D A Saad ◽

M M Francis ◽

F A Mohamed

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Plasma Levels ◽

Histopathological Examination ◽

Direct Bilirubin ◽

Hepatic Tissue ◽

Control Group ◽

Tissue Samples ◽

Tnf Α ◽

The Common

Abstract Background Cholestasis is the obstruction or the reduction in bile flow that results in intrahepatic accumulation of bile constituents, which progresses to develop liver pathology. Common bile duct ligation (BDL) in rodents is an experimental model of cholestasis that has been carried out in research for many years. BDL model of cholestatic liver injury involves other mechanisms, including oxidative stress, inflammation, and fibrogenesis. Antioxidant, antiinflammatory or antiapoptotic properties gained much interest for the amelioration of liver dysfunction. Aim the aim of this study is to assess the possible protective effects of onion supplementation on hepatic structural and functional alterations induced by BDL in rats, which reflect the effects of cholestasis resulting from intrahepatic accumulation of bile. Methods Thirty adult female Wistar rats were randomly and equally allocated into three groups: (1) control group, (2) BDL group; subjected to ligation of the common bile duct and (3) Onion-supplemented BDL groups (O-BDL). Both control and BDL groups received distilled water (solvent for onion powder) daily by gavage for 4 weeks. Onion-supplemented BDL group (O-BDL); subjected to ligation of the common bile duct and then received 500 mg/kg of onion powder dissolved in distilled water, daily by gavage for 4 weeks. At the end of the experimental period, plasma levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), direct bilirubin, total proteins, total antioxidant capacity (TAC), tumor necrosis factor-α (TNF-α), and hepatic tissue level of malondialdehyde (MDA) and transforming growth factor-β (TGF-β) were measured for all groups. In addition, histopathological examination of liver tissue samples was performed for the three groups. Results Plasma levels of ALT, AST, ALP, direct bilirubin, TNF-α and hepatic tissue levels of MDA and TGF-β were significantly increased and TAC was significantly decreased in the BDL group compared to the control group. In addition, altered architecture was detected in hepatic tissue samples of BDL group. Onion supplementation significantly decreased the plasma levels of ALT, AST, ALP, direct bilirubin, TNF-α and hepatic tissue levels of MDA and TGF-β in the O-BDL group when compared to the BDL group. Total proteins level was not significantly different among all the studied groups. In addition in O-BDL group, histopathological examination of liver revealed near normal structure of hepatic tissue. Conclusion BDL induces hepatic structural alterations and functional disturbances. Onion supplementation inhibits inflammation and oxidative insults that associate BDL, and subsequently protects against BDL-induced liver injury.

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Neuroglobin in Neurons of the Frontal and Parietal Cortex of White Rats in Cholestasis

Journal of Anatomy and Histopathology ◽

10.18499/2225-7357-2020-9-1-24-29 ◽

2020 ◽

Vol 9 (1) ◽

pp. 24-29

Author(s):

S. V. Emel'yanchik ◽

O. A. Karnyushko ◽

S. M. Zimatkin

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Parietal Cortex ◽

Pyramidal Neurons ◽

White Male ◽

Male Rats ◽

Control Group ◽

White Rats ◽

The Common ◽

Cytophotometric Analysis

The aim of the study was to investigate the distribution and content of neuroglobin in the pyramidal neurons of the frontal and parietal cortex of white rats during simulated cholestasis.Material and methods. The study included 60 outbred white male rats weighed 200–250 g. Cholestasis was simulated by ligation of the common bile duct in the porta hepatis area (main group, n=30). Animals of the control group (n=30) were performed a false operation preserving physiological bile outflow. Sections of the frontal and parietal cortex of white rats were selected for investigation. The content and distribution of neuroglobin was detected immunohistochemically on paraffin sections using mouse monoclonal primary antibodies Anti- Neuroglobin antibody (Abcam). Cytophotometric analysis was used to perform quantitative assessment of the content of the studied molecular marker; after that statistical analysis was performed.Results. It was found that the content of neuroglobin in the pericarions of neurons of the frontal and parietal cortex modified in a wave-like mode. After ligation of the common bile duct, the content of neuroglobin significantly decreased in 2, 10 and 45 days (minimum on the 10th day) in the frontal cortex and in 90 days in the parietal cortex, and increased in 5 and 20 days of the experiment (maximum on the 20th day).Conclusion. In cholestasis, the content of neuroglobin in the pericarions of neurons of the frontal and parietal cortex modifies in waves: a decrease is observed on the 2nd, 10th, 45th day; an increase is observed on the 5th and 20th day; a recovery is observed on the 90th day.

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THE INTRODUCTION OF THE PHOTOSENSITIZER “FOTOLON” INTO THE COMMON BILE DUCT: INFLUENCE ON EXPERIMENTAL ANIMALS

Hepatology and Gastroenterology ◽

10.25298/2616-5546-2020-4-2-189-195 ◽

2020 ◽

Vol 4 (2) ◽

pp. 189-195

Author(s):

R. S. Shyla ◽

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Morphological Changes ◽

Laboratory Data ◽

Vital Signs ◽

Physiological Solution ◽

Control Group ◽

Histological Structure ◽

Experimental Animals ◽

The Common

Background. Photodynamic therapy of liver diseases involves the introduction of photosensitizers into the common bile duct. Objective – to evaluate the effect on animals of under pressure introduction of the photosensitizer “Photolon” into the common bile duct. Material and methods. The control group was injected with physiological solution under pressure, the experimental one – with “Photolon”. The vital signs of the animals, the laboratory data were studied, a histological examination of the liver and duct was carried out. Results. The blood parameters of the experimental animals and their postoperative condition were not statistically different from those of the control group (p≤0.05). The liver and common bile duct had normal histological structure. Conclusions. The under pressure introduction of the photosensitizer “Photolon” into the common bile duct causes no morphological changes in the liver tissues and common bile duct and has no toxic effect on animals.

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Anastomotic Biliary Stricture Development after Liver Transplantation in the Setting of Retained Prophylactic Intraductal Pediatric Feeding Tube: Case and Review

Case Reports in Hepatology ◽

10.1155/2018/4707389 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Patrick T. Koo ◽

Valentina Medici ◽

James H. Tabibian

Keyword(s):

Liver Transplantation ◽

Bile Duct ◽

Common Bile Duct ◽

Biliary Stricture ◽

Magnetic Resonance Cholangiopancreatography ◽

Feeding Tube ◽

Filling Defect ◽

Ultrasound Finding ◽

The Common ◽

Pediatric Feeding

The biliary anastomosis remains a common site of postoperative complications in liver transplantation (LT). Biliary complications have indeed been termed the “Achilles’ heel” of LT, and while their prevention, diagnosis, and treatment have continued to evolve over the last two decades, various challenges and uncertainties persist. Here we present the case of a 33-year-old man who, 10 years after undergoing LT for idiopathic recurrent intrahepatic cholestasis, was noted to have developed pruritus and abnormalities in serum liver biochemistries during routine post-liver transplant follow-up. Abdominal ultrasound revealed a linear, 1.5 mm hyperechoic filling defect in the common bile duct; magnetic resonance cholangiopancreatography demonstrated a curvilinear filling defect at the level of the choledochocholedochostomy, corresponding to the ultrasound finding, as well as an anastomotic biliary stricture (ABS). On endoscopic retrograde cholangiography (ERC), a black tubular stricture with overlying sludge was encountered and extracted from the common bile duct, consistent with a retained 5 Fr pediatric feeding tube originally placed at the time of LT. The patient experienced symptomatic and biochemical relief and successfully underwent serial ERCs with balloon dilatation and maximal biliary stenting for ABS management. With this case, we emphasize the importance of ensuring spontaneous passage or removal of intraductal prostheses placed prophylactically at the time of LT in order to minimize the risk of chronic biliary inflammation and associated sequelae, including cholangitis and ABS formation. We also provide herein a brief review of the use of prophylactic internal transanastomotic prostheses, including biliary tubes and stents, during LT.

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A Novel End-to-End Biliary-to-Biliary Anastomosis Technique for Iatrogenic Bile Duct Injury of Strasberg-Bismuth E1-4 Treatment: A Retrospective Study and in vivo Assessment

Frontiers in Surgery ◽

10.3389/fsurg.2021.747304 ◽

2021 ◽

Vol 8 ◽

Author(s):

Dong Ma ◽

Pengpeng Liu ◽

Jianwei Lan ◽

Baiyang Chen ◽

Yang Gu ◽

...

Keyword(s):

Retrospective Study ◽

Bile Duct ◽

Bile Duct Injury ◽

Biliary Stricture ◽

Control Group ◽

Benign Biliary Stricture ◽

Reconstruction Procedure ◽

End To End ◽

Biliary Anastomosis ◽

Iatrogenic Bile Duct Injury

Background: An iatrogenic bile duct injury (IBDI) is a severe complication that has a great impact on the physical and mental quality of life of the patients, especially for patients with postoperative benign biliary stricture. The effective measures for end-to-end biliary-to-biliary anastomosis intraoperative are essential to prevent the postoperative bile duct stricture, but also a challenge even to the most skilled biliary tract surgeon.Objective: A postoperative benign biliary stricture is an extremely intractable complication that occurs following IBDI. This study aimed to introduce a novel end-to-end biliary-to-biliary anastomosis technique named fish-mouth-shaped (FMS) end-to-end biliary-to-biliary reconstruction and determine the safety and effectiveness for preventing the postoperative benign biliary stricture in both rats and humans.Methods: In this study, 18 patients with biliary injury who underwent an FMS reconstruction procedure were retrospectively analyzed. Their general information, disease of the first hospitalization, operation method, and classification of bile duct injury (BDI) were collected. The postoperative complications were evaluated immediately perioperatively and the long-term complications were followed up at the later period of at least 5 years. An IBDI animal model using 18 male rats was developed for animal-based evaluations. A bile duct diathermy injury model was used to mimic BDI. The FMS group underwent an FMS reconstruction procedure while the control group underwent common end-to-end biliary-to-biliary anastomosis, a sham operation group was also established. The blood samples, liver, spleen, and common bile duct tissues were harvested for further assessments.Results: In the retrospective study, there was no postoperative mortality and no patient developed cholangitis during the 5-years postoperation follow-up. In the study of IBDI animal models, compared with the control group, the FMS reconstruction procedure reduced the occurrence of benign biliary stenosis, liver function damage, and jaundice. The blood tests as well as morphological and pathological observations revealed that rats in the FMS reconstruction group had a better recovery than those in the control group.Conclusions: An FMS reconstruction procedure is a safe and efficient BDI treatment method.

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