Temporary replacement of the common biliary duct by a silicone tube, as an urgent repair of iatrogenic injury. Experimental study in pigs.

Daniel A Napolitano, MD, PhD, Xavier Rodriguez Bertola, MD, Gabriela M Sambuelli, MD, Federico Moser. Universidad Catolica de Cordoba

Surgery of the biliary tract is complex, and its volume has increased with iatrogenic injuries and living donor transplantation. The aim of this study and original idea was to analyze if the common duct can be temporarily replaced by a silicon tube originaly designed. We used nine 18-20kg pigs. They were operated on, and their bile duct was replaced by a 100% silicone tube (original design and manufacture, registered). All pigs underwent laboratory tests, magnetic resonance imaging, intraoperative ultrasound, cholangiography and biliar manometry with pathological biopsy examination within 60 days from the initial surgery. All pigs survived the first surgery over 60 days without laboratory evidence of evident cholestasis. Nine pigs were re-operated on at 60 days showing dilated common bile duct and hepatic ducts doubling its original size without dilating the intrahepatic bile ducts. There were no clinical, relevant laboratory or biopsy signs showing cholestasis. This experience represents the initial intention to find an optimal situation and prosthesis for replacement of the thin biliary tract, in surgical emergencies or palliative situations. The silicon tube, is a positive transitory answer that remains permeable. A non-fibrotic reaction was found that allows a posterior definitive procedure, maintaining a good nutritional status.

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