A small-bowel segment as a total extrahepatic bile duct replacement

T. C. Bottger and T. Junginger
Department of General and Abdominal Surgery, Johannes Gutenberg-University, Mainz, Germany.

The effect of a small-bowel segment as a total extrahepatic bile duct replacement, with preservation of the bile passage through the papilla of Vater, was examined in 12 pigs followed up for 420 days. No complications during or after surgery were observed in any of the animals. The laboratory parameters were within normal range during the entire observation period. No anastomotic stenosis was evident on percutaneous transhepatic cholangiography in animals examined 2, 6, or 12 months after surgery. The intrahepatic biliary tract was not dilated. There was obvious peristalsis of the grafted small-bowel toward the papilla of Vater. Autopsies showed that the grafts had healed without any sign of irritation. Histologically, the structure of the graft remained undisturbed. There was a clear distinction between the mucosa of the bile duct and that of the small bowel, with no sign of chronic infection. In the graft as well as in the vascular pedicle, the nerve fibers were intact. Liver biopsy showed no pathologic changes. In light of the results of these experiments, the small-bowel segment appears to be a very promising substitute for the injured extrahepatic biliary duct.