Introduction: In small-caliber bile ducts (BD), performing a well-functioning hepatico-jejunal (HJ) anastomosis can be challenging: bile leakage and stricture formation are well-known anastomotic complications. We have developed a biodegradable stent (BDS) and showed that it can be safely and effectively used in conventional HJ anastomosis, as well as in the treatment of cystic duct leakage and benign biliary strictures (GIE 2007). In addition, we have reported good results in patients with novel-technique pancreato-duodenectomy, where the anastomosis was created using purse-string technique and a BDS. We hypothesized that, instead of interrupted sutures, in small caliber BDs it might be easier and safer to create a purse-string anastomosis, and to use a BDS to ensure its patency. The aim of this study was to investigate the use of this novel technique for HJ, featuring a purse-string anastomosis and a BDS, and to compare the results to a conventional anastomosis without any stent in the minipigs. Materials and
Methods: In this study the self-expanding PLA-BaSO₄ BDSs (length 25 mm, wall 0.25 mm, diam 4/5 mm) and 23-kg minipigs were used. Cholecystectomy was performed and BD inner diameter measured. HJ was performed randomly either conventionally with interrupted sutures without any stent (n=5) or by the novel purse-string technique (n=4), where a BDS was first introduced into the BD, after which the BD with the stent was slide with the aid of 3 stay-sutures well inside the jejunal purse-string, which was then tightened. The animals were followed by repeated x-rays and liver chemistry.
Results: The preoperative BD diameter was similar in the groups (aver 4.2 mm). 10 interrupted sutures in average were used in the conventional anastomosis. The time needed for creating the anastomosis was similar in the two groups (28.2 min in the conventional and 25 min in the purse-string + stent group). In the conventional group, one animal was sacrificed due to uncontrolled anastomotic bile leak on the 2nd postoperative day, and another animal developed a mild liver function failure with increased liver values at 1 month, and almost normal values at 3 months. All other animals (3/5 in conventional group and 4/4 in purse-string + stent group) had no signs of anastomotic leakage or liver function failure. In the abdominal radiograph the biodegradable stent had disappeared from all animals by 3 months.
Conclusions: The described novel HJ technique featuring a purse-string anastomosis and a BDS is easy and safe to perform, and seems to ensure a well-functioning anastomosis in small-calibre BDs. These encouraging initial results point to further trials in the near future.