CIRCUMFERENTIAL CHOLEDOCHOPLASTIES WITH AUTOLOGOUS VENOUS AND ARTERIAL GRAFTS

Circumferential choledochoplasties with vascular grafts have rarely be en attempted either experimentally or in clinical practice. In this st udy, choledochoplasties using autologous venous and arterial grafts we re performed in rats. Sixty-four rats were randomly selected into five treatment groups: A) venous interpositional graft replacement of a ch oledochus gap without a stent; B) venous graft with prolene stent; C) venous graft with polyethylene stent; D) arterial graft; E) a control group with simple resection between ligatures in the choledochus. The operative mortality in treatment groups B, C, D, and E, was 0, and 13% in group A. At 12 weeks follow-up, all the rats in group E had died, whereas, 52.2% (P < .05) of the rats in group A, 30% of the rats in gr oup B, 57% of the rats in group C, and 92.8% of the rats in group D su rvived treatment. Surviving animals were sacrificed at 3 months for fu rther examination. The morphology and caliber of the common bile duct of these rats were normal in 25% of the rats in group A, 33% of the ra ts in group B, 25% of the rats in group C, and 84.6% of the rats in gr oup D. Proximal dilations were found in the rats presenting with abnor mal morphology. The dilations were less marked in the group treated by arterial choledochoplasties. Laboratory and clinical cholestatic para meters were within normal ranges in the presence of common bile duct d ilations less than four times the normal duct caliber. Electron micros copic examination of the venous and arterial graft at 3 months follow- up revealed a fibrous ring composed of collagen fibers, fibroblasts, a nd remnants of elastic fibers. Regenerated ductal epithelium encompass ed both types of grafts. Epithelialization was more pronounced in veno us grafts as compared to arterial grafts. Biliary epithelium was able to colonize the venous grafts and resume cell specialization and funct ion as in normal biliary epithelium. The most satisfactory results wer e obtained using venous grafts with stents or by using arterial grafts . (C) 1993 Wiley-Liss, Inc.