The choice of surgical timing for biliary duct reconstruction after obstructive bile duct injury: an experimental study.

ABSTRACT

BACKGROUND/AIMS: The surgical time of obstructive bile duct injury when biliary-enteric reconstruction is needed remains controversial till now. METHODOLOGY: Sixty dogs models of bile duct injury were established and divided into six groups according to the days (0, 5, 10, 15, 20, 30 days) of injury. At the time of surgery, biopsy was taken and Roux-en-Y hepaticojejunostomy was performed. The morphology and local histopathology of bile duct, the liver function in different periods were observed. Surgical complications and survival were also evaluated. RESULTS: In the early time (5-10 days), the proximal bile ducts dilated continuously and showed acute inflammation change, but slow in the later period (10-30 days). Moreover, the bile duct wall gradually transformed into fibroplasias from the inflammatory edema after 10 days. During the development of jaundice, the liver function was damaged, especially after 20 days. After reconstructing, the bile leakages in the groups that repaired within 10 days were more than the ones in other groups (7 vs. 3, p < 0.05), and the malnutrition or organ failure occurring in 3 months was most at the 30-day group (n = 7, p < 0.05). CONCLUSIONS: The period between 10 and 20 days after bile duct obstruction may be optimal for surgical repair.