[Microsurgical bile duct anastomosis: animal experiment and clinical study]

In 10 Göttingen-minipigs an end-to-end anastomosis of the normal common bile duct was accomplished under the microscope with 11/0 Polygalactin-sutures. Biliary flow was controlled by serum concentration of alkaline phosphatase, by cholangiography and by dynamic hepato-biliary scintigraphy 2 weeks, and 3 and 6 months after the operation. Anastomoses were judged by macroscopic, microscopic and scanning electronmicroscopic examination 6 or 12 months postoperatively. The anastomoses presented no stenosis at all, only a light periductal fibrosis with intact luminal epithelium. Alkaline phosphatases and cholangiography showed a normal pattern, the scintigraphy presented dyskinesia after 2 weeks and normal flow at the later controls. After a microsurgical operation one patient showed a normal anastomosis after 6 months. A biliary anastomosis should be made by microscope in all patients with a long life span and unchanged bile duct wall in spite of the more difficult operation.