Related Experiment Videos
Sutured or fibrin-glued laparoscopic choledochojejunostomy
D B Jones1, J D Brewer, T A Meininger
1Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Surgical Endoscopy
|September 1, 1995
Summary
Laparoscopic choledochojejunostomy (LCJ) using sutures is safe and effective for biliary obstruction. Thrombin-activated fibrin glue is not recommended for creating biliary anastomoses due to a high leak rate and lower tensile strength.
Area of Science:
- Minimally invasive surgery
- Gastroenterology
- Surgical innovation
Background:
- Minimally invasive techniques for choledochojejunostomy (LCJ) offer potential benefits for unresectable periampullary neoplasms.
- Fibrin glue is a biologic adhesive that could potentially replace sutures in LCJ, promoting healing without strictures.
Purpose of the Study:
- To evaluate the technical feasibility of laparoscopic choledochojejunostomy (LCJ).
- To assess the efficacy of thrombin-activated fibrin glue in LCJ within an animal model of biliary obstruction.
Main Methods:
- Domestic pigs underwent laparoscopic cholecystectomy and bile duct ligation.
- LCJ was performed using intracorporeal suturing (n=7) or fibrin glue with stay sutures (n=7).
- Control animals (n=7) underwent open laparotomy bypass; outcomes included ambulation, oral intake, liver enzymes, and anastomotic tensile strength at 6 weeks.
Main Results:
- All LCJ methods normalized liver function within 7 days.
- The fibrin glue group experienced a 43% anastomotic leak rate in the first week.
- Sutured LCJ showed similar efficacy to open bypass but with faster recovery; fibrin glue LCJ had lower tensile strength and early leaks.
Conclusions:
- Thrombin-activated fibrinogen is not suitable as a primary method for biliary anastomoses.
- Laparoscopic choledochojejunostomy using intracorporeal suturing techniques can be performed safely and effectively.