Published online Dec 14, 2020. doi: 10.3748/wjg.v26.i46.7312
Peer-review started: August 27, 2020
First decision: September 30, 2020
Revised: October 6, 2020
Accepted: November 2, 2020
Article in press: November 2, 2020
Published online: December 14, 2020
Processing time: 108 Days and 15.3 Hours
Several approaches have been explored to address extrahepatic biliary duct injury (BDI). The high incidence of complications affects postoperative recovery. Animal-derived artificial bile duct (ada-BD), a nonimmunogenic scaffold, could replace the defect via providing good physiological conditions for the regeneration of autologous bile duct structures without changing the original anatomical and physiologic conditions.
To assess the safety and feasibility of a novel animal derived material for treating extrahepatic BDI in pigs.
To evaluate and confirm the long-term feasibility of a novel heterogenous ada-BD for treating extrahepatic BDI.
Eight pigs were randomly divided into two groups. Surgery was performed to develop a bile duct injury and repair model via a 2 cm long novel heterogenous ada-BD to repair an approximately 2 cm segmental defect of various parts of the common bile duct (CBD) for all pigs. Group A received ada-BD-to-duodenum anastomosis to repair the distal CBD defect, and group B received ada-BD-to-CBD anastomosis to repair the intermedial CBD defect. The endpoint for observation was 6 mo (group A) and 12 mo (group B) after the operation.
All experimental animals survived until the endpoints for observation. The liver function was almost regular. Histologic analysis indicated a marked biliary epithelial layer covering the neo-bile duct and regeneration of the submucosal connective tissue and smooth muscle without significant signs of immune rejection. In comparison, the submucosal connective tissue was more regular and thicker in group B than in group A, and there was superior integrity of the regeneration of the biliary epithelial layer. Despite the advantages of the regeneration of the bile duct smooth muscle observed in group A, the effect on the patency of the ada-BD grafts in group B was not confirmed by macroscopic assessment and cholangiography.
Repairing a CBD defect with an ada-BD appears to be a feasible and safe approach. A large sample study is needed to confirm the durability and safety of these preliminary results.
Ada-BD showed a high similarity between the bovine ureter and bile duct. The decellularized bovine ureter provided an optimal pathophysiological condition and a novel material to avoid immunological rejection. All the encouraging results bring a new hope for bile duct repairment.