An experimental study on repair of bile duct defect with free peritoneal graft

Objective To explore the feasibility of using autogenous free peritoneal graft for repair of the bile duct defect and to find an ideal material for the clinical management of the bile duct injury. Methods 1) Twenty-four local healthy mongrel dogs weighting 8-12 kg underwent right rectus abdominal laparotomy and had 0.8-1.0 cm of the anterior one-third to two-thirds of their bile duct resected to establish the model of bile duct injury. The parietal peritoneal flap was harvested near the abdominal incision with the similar dimension of the bile duct defect and sutured to the edges of the excised bile duct with the coverage of omentum outside. 2) Laparotomy was performed again at following intervals: 2 weeks (n=3, died), 4 weeks (n=4), 8 weeks (n=4), 12 weeks (n=4), 28 weeks (n=4) and 52 weeks (n=4). The tissues of liver and common bile duct, especially the repaired segment, were harvested for light microscopic examination to observe the healing process of bile duct and morphological changes in liver. 3) Cholangiography was performed at 26 and 50 weeks after operation. Results 1) Four dogs died and the other 20 were healthy at the time of killing with normal appetite and body weight without jaundice. 2) Microscopic examination showed that the repaired segment was completely occupied by biliary epithelium after 28 weeks, and the bile duct wall was similar to the normal canine common bile duct. The liver had no pathological damages. 3) The cholangiography showed that the lumen remained of normal caliber, and there were no signs of biliary dilation or stricture in spite of 1 stricture at 26 weeks. Conclusions Free autogenous peritoneum can be used for regeneration of bile duct tissue in a canine model because of such advantages as abundance, potential ability of regeneration, antibacterial effect, convenience and so on. The covering omentum can help the early reconstruction of blood vessels.