Reconstrução da via biliar com tubo de segmento jejunal : nova tecnica cirurgica - estudo experimental em cães / Recontruction of the biliary tract with jejunal segment tube : new surgical technique - experimental study in dogs

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

An ideal model for reconstruction of extensive lesions of the biliary tract has not been found so far. The Roux-en-Y reconstruction is a classic reconstruction and presents advantages as the low incidence of intestine contents reflux to the biliary tract. However, since this is not anatomical, it impedes or impairs the endoscopic access to the biliary tract. A physiological technique to replace the common bile duct is the interposition of a pediculated segment of jejunum between the biliary tract and the duodenum, described since 1950 and successfully performed in several patients. However, this technique has not been widely adopted. The present experimental study was proposed for reconstruction of the biliary tract in a physiological manner, by application of the Monti principle to the biliary tract, which is well established in humans for the urinary tract. This technique comprises detubulization and transverse retubulization of a segment of jejunum, changing the mucosal folds in longitudinal direction, thus enhancing the flow of liquids inside it. Its application for reconstruction of the biliary tract would allow endoscopic access to the biliary tract, for both diagnostic and therapeutic purposes. Thirteen dogs were operated in the present study; initially, laparoscopic ligation of the common bile duct of dogs was performed to induce extrahepatic cholestasis. After one week, biliodigestive derivation was performed by laparotomy with interposition of the aforementioned jejunal tube between the dilated biliary tract and the duodenum. The dogs were submitted to biochemical dosage of alanine and aspartate transaminases, total bilirrubin, alkaline phosphatase and gamma-glutamyltransferase preoperatively and weekly for six weeks postoperatively. Another laparotomy was then performed with resection of a monoblock specimen from the biliary tract-jejunal tube-duodenum for macroscopic analysis and the animals were killed. Bile was collected from the dogs upon biliodigestive derivation and upon killing. From the 13 animals submitted to laparoscopic ligation of the common bile duct, one was excluded because significant dilation of the biliary tract was not achieved. Three dogs died after biliodigestive derivation; among these, only one exhibited peritonitis upon autopsy. Thus, data on nine dogs were submitted to statistical analysis. These dogs exhibited obstructive jaundice at seven days after ligation of the common bile duct, as demonstrated by biochemical examinations. All nine animals presented statistically significant gradual reduction of cholestasis after biliodigestive derivation by interposition of a pediculated jejunal tube and were healthy until study completion. The mean values of total bilirubin, alkaline phosphatase and gamma glutamyltransferase at one week after ligation of the biliary tract were: 4.39; 3251.7; and 66.1. The values of these variables at six weeks after biliodigestive derivation were 0.11 ; 323.1 and 10.7, respectively. It was concluded that interposition of a jejunal segment tube between the previously ligated common bile duct and the duodenum was effective for decompression of the biliary tract. Macroscopic analysis of the collected specimens revealed good integration between the biliary tract and the tube and between the tube and the duodenum. Longitudinal sectioning of the specimens revealed optimal healing of the anastomosed structures and patency of the jejunal tube

ASSUNTO(S)

gastroenterology gastroenterologia trato biliar bile biliary tract

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