[Experimental biliary reconstruction with a Dacron graft which preserves the function of papilla Vater]

Roux-en-Y cholangiojejunostomy has been widely accepted as a method of biliary reconstruction after resection of the bile duct, however complications such as cholestasis, cholangitis and peptic ulcer attributable to the loss of papillary functions are frequently encountered after this procedure. In this point of view, the author experimentally studied biliobiliary anastomosis with a Dacron vascular graft to preserve normal bile passage through the duodenal papilla. End-to-end choledocho-graft-choledochostomy with a Dacron vascular graft coated with collagen (Hemashield) was carried out in 10 pigs. Out of them three died of complications during the 13th to 26th the POD, and seven were sacrificed 6 weeks after the operation. Two weeks after biliary grafting (n = 3) the grafts were surrounded by thin fibrous tissue and microscopically collagen fibers infiltrating into pores of the graft were noted, however after 6 weeks the grafts were spontaneously detached from the bile duct and floated in bile. The covered fibrous tissue was remained and the anastomotic site was replaced with soft granulation tissue, where infiltration of inflammatory cells were microscopically noted. Caliber of the anastomotic site was not smaller and but for slight elevation of total bile acid level blood biochemistry did not show cholestasis and cholangitis. The papillary function was manometrically well maintained. A Dacron graft shielded by collagen seemed to be inadequate material as a permanent bile duct graft, however granulation tissue after spontaneous removal of the graft may be covered with biliary epithelium, and may heal maintaining normal papillary function.