Common bile duct anastomosis using fibrin glue
H. B. Kram, M. A. Garces, S. R. Klein and W. C. Shoemaker
Transection of the common bile duct (CBD) secondary to iatrogenic or
civilian trauma is a devastating injury associated with a high incidence of
complications, especially biliary fistula and stricture formation. We
evaluated the efficacy of Fibrin Sealant--a biologic adhesive containing
highly concentrated human fibrinogen--in primary end-to-end anastomosis of
the transected CBD in ten adult mongrel dogs. Postoperative T-tube stents
in the CBD anastomosis and abdominal drainage were not used. Only two
absorbable sutures were used for each CBD anastomosis. The dogs were
reexplored postoperatively at intervals varying from one week to nine
months; cholangiography was performed at postoperative intervals varying
from one to six months. Examination of CBD specimens harvested one month or
more after surgery revealed complete healing and no signs of previous
injury. Histologic examination disclosed well-healed ductal tissue, without
a significant inflammatory response. One dog had an anastomotic leak, and
two had moderate narrowing of the CBD anastomosis. Our experience in
experimental CBD anastomosis indicates that Fibrin Sealant helps seal
biliary anastomoses against leakage; controls bleeding from cut edges of
bile duct segments; has good systemic and local compatibility; may promote
bile duct wound healing; and significantly reduces the number of sutures
needed for primary repair, thereby decreasing the potential for anastomotic
ischemia, mucosal damage, and biliary stricture formation.
