Progress and Current Limitations of Materials for Artificial Bile Duct Engineering

Bile duct injury (BDI) and bile tract diseases are regarded as prominent challenges in hepatobiliary surgery due to the risk of severe complications. Hepatobiliary, pancreatic, and gastrointestinal surgery can inadvertently cause iatrogenic BDI. The commonly utilized clinical treatment of BDI is biliary-enteric anastomosis. However, removal of the Oddi sphincter, which serves as a valve control over the unidirectional flow of bile to the intestine, can result in complications such as reflux cholangitis, restenosis of the bile duct, and cholangiocarcinoma. Tissue engineering and biomaterials offer alternative approaches for BDI treatment. Reconstruction of mechanically functional and biomimetic structures to replace bile ducts aims to promote the ingrowth of bile duct cells and realize tissue regeneration of bile ducts. Current research on artificial bile ducts has remained within preclinical animal model experiments. As more research shows artificial bile duct replacements achieving effective mechanical and functional prevention of biliary peritonitis caused by bile leakage or obstructive jaundice after bile duct reconstruction, clinical translation of tissue-engineered bile ducts has become a theoretical possibility. This literature review provides a comprehensive collection of published works in relation to three tissue engineering approaches for biomimetic bile duct construction: mechanical support from scaffold materials, cell seeding methods, and the incorporation of biologically active factors to identify the advancements and current limitations of materials and methods for the development of effective artificial bile ducts that promote tissue regeneration.

Gallstone ileus: a review

Background Gallstone ileus is an important complication of cholecystolithiasis. In general, surgery is the treatment of choice for such cases, but clinicians face difficulty in the selection of an appropriate approach. Closure of a cholecystoenteric fistula can be achieved through one-stage or two-stage operation. Two-stage operation has a lower mortality rate than a one-stage procedure, but persistence of the cholecystoenteric fistula is associated with the risk of carcinogenesis and recurrence of gallstone ileus.Objective This study reviews the different surgical approaches according to the impaction site of the gallstone, using data of previous studies by our group and clinical reports in the literature.Conclusions First, for cases involving impaction at the duodenum, the cholecystoenteric fistula can be repaired in the same surgical field, and one-stage operation obtains favourable outcome; hence, one-stage operation is considered as treatment of choice. Second, for cases involving impaction at the small intestine, natural closure of the cholecystoenteric fistula or low mortality is expected; hence, two-stage operation may be performed, possibly using minimally invasive laparoscopy. Third, for cases involving impaction at the colon, natural closure of the cholecystocolonic fistula is unlikely, and patients have a high risk of reflux cholangitis due to faecal fluid; hence, one-stage operation is considered as treatment of choice.

Retrograde stenting of the bile ducts for benign hepatopancreatoduodenal diseases

Aim.To evaluate the immediate results of endoscopic retrograde stenting of bile ducts in benign hepatopancreatoduodenal diseases and to justify enlargement of indications for surgery.Material and methods.There were 341 patients with various benign hepatopancreatoduodenal diseases for the period 2007–2017. Plastic stents were installed in 326 (95.6%) patients, metal self-expanding stents – in 15 (4.4%) patients.Results.There was a tendency to increase of the number of stenting procedures in patients with benign hepatopancreatoduodenal diseases that was primarily due to expansion of indications for this intervention. Therapeutic and prophylactic purposes of biliary stenting were determined. The main objectives of therapeutic stenting were bile drainage restoration in obstructive jaundice, reduction of extra- and intrahepatic biliary pressure, as well as drainage of cavities in liver communicating with biliary system. The main prophylactic goal was to prevent violation of bile outflow after endoscopic manipulations on the major duodenal papilla at high risk of migration of stones from gallbladder and reflux cholangitis. Severe complications of endoscopic transpapillary procedures were not observed.Conclusion.The indications for endoscopic transpapillary stenting of the bile ducts in case of benign hepatopancreatoduodenal diseases were systematized and reasonably expanded. Immediate results of biliary stenting confirm high efficacy of the method.

Current assessment of choledochoduodenostomy: 130 consecutive series

IntroductionCholelithiasis usually can be managed successfully by endoscopic sphincterotomy. Choledochoduodenostomy (CDD) is one of the surgical treatment options but its acceptance remains debated because of the risk of reflux cholangitis and sump syndrome. The aim of this study was to assess the current features and outcomes of patient undergoing CDD.Patients and methodsWe retrospectively analysed the surgical results of consecutive 130 patients treated by CDD between 1991 and 2013 and excluded five cases with a malignant disorder. Indications for surgery included endoscopic management where stones were difficult or failed to pass and primary common bile duct stones with choledochal dilatation. Incidences of reflux cholangitis, stone recurrence, pancreatitis or sump syndrome were investigated and the data between end-to-side and side-to-side CDD were compared.ResultsReflux cholangitis and stone recurrence was 1.6% (2/125) and 0% (0/125) of cases by CDD. There is no therapeutic-related pancreatitis in CDD. Sump syndrome was not also observed in side-to-side CDD.ConclusionsThis study is a first comparative study between end-to-side and side-to-side CDD. The surgical outcomes for CDD treatment of choledocholithiasis were acceptable. The incidence of reflux cholangitis, stone recurrence, pancreatitis and sump syndrome was very low.

Ultrasound imaging of biliodigestive anastomoses

The authors conducted a retrospective analysis of medical records of 71 patients operated on biliary obstruction with biliodigestive anastomoses. In the early postoperative period of 71 patients with various types of complications were observed in 14 (19,7%) patients of еarly postoperative mortality was 5,6% (4 patients) and 56 patients were observed from 1 year to 7 years after surgery. All patients in the postoperative period were performed trans-abdominal ultrasound imaging, tomography, magnetic resonance tomography, fistulography. The technique of improving ultrasonic visualization of the distal bile duct and area BDA and ultrasound semiotics state of biliodigestive anastomoses in the early and late postoperative period were developed. Ultra-sound criteria of insolvency biliodigestive anastomoses in the early postoperative period, and signs of scarring biliodigestive anastomoses and development of reflux cholangitis in the late postoperative period were carried out and systematized. High precision of data of ultrasonic imaging with a clinical diagnosis was noted. The sen-sitivity of ultrasound in detecting reflux cholangitis amounted to 100%; specificity – 83,7%; accuracy was 87,5%. The sensitivity of ultrasound in detecting scar stricture biliodigestive anastomoses amounted to 87,5%; the specificity was 93,8% of the respondents; the accuracy of 92,9%.