EVALUATION OF NOVEL PORCINE PERICARDIAL BIOMATERIAL FOR VENTRAL AND INGUINAL HERNIA REPAIR. THE RESULTS OF A NON-RANDOMIZED CLINICAL TRIAL.

Using the mesh for hernia repair is the most common type of hernia surgery. There are many types of meshes made of various synthetic materials, but all of these meshes have their own respective disadvantages. The aim of this study was to provide preliminary results of a non-randomized clinical trial evaluation of novel porcine grafts XI-S+® (Colorado Therapeutics LLC. USA) for ventral and inguinal hernia repair. All patients underwent a standardized surgical procedure. Onlay surgical repair technique has been performed in ten patients with ventral hernia and Lichtenstein tension-free method has been used for ten patients with inguinal hernia repair. The XI-S+® mesh fixation was performed with multiple simple interrupted sutures using prolene thread. The average age of the patients with ventral hernia was 54±14 years, and 30% of patients were female and 70% of patients were male. The average age of the patients with inguinal hernia was 62.5±9.4 years, and 10% of patients were female and 90% of patients were male. The average hospitalization length was 2 days. During three years of observation, no recurrence of hernia was observed in patients. The XI-S + ® mesh has anti-adhesive properties, is extremely resistant to infections, provides favorable conditions for engraftment, early activity and patient rehabilitation. The clinical studies of the patients that underwent ventral and inguinal hernia repair using XI-S+® mesh have shown that the post-operative pain was minimal and easily controlled by the use of analgesics. As for the sensation of the mesh, in some patients it has been present up until 1 month from surgery, but it fully disappeared by the end of the 3rd month.

RELATIONSHIP BETWEEN ORAL SQUAMOUS CELL CARCINOMA AND IMPLANTS (REVIEW).

In this review, we have discussed the relationships between oral squamous cell carcinoma (OSCC) and dental implants. In the last decade, dental implants have been widely used for the treatment of complete or partial edentulism. Despite the fact that they have seen incredible success and the use of dental implants increases, concerns over safety and efficiency is rising as well. The literature analysis has shown that the number of reported cases when the OSCC development is associated with peri implantitis is gradually increasing. The possibility of squamous cell carcinoma development must be considered when evaluating the peri-implantitis. We highly recommend periodic oral and radiographic examination after the implant placement. The patients with peri-implantitis that do not respond to conventional treatment methods, and the patients who have a severe or rapid progression of peri-implantitis require biopsy. The histopathological examination will aid with the differential diagnosis between peri-implantitis and OSCC, and hence, provide the correct diagnosis.

CURRENT CONDITION AND CHALLENGES IN TREATMENT OF NON-HEALING WOUND AFTER RADIATION THERAPY (REVIEW).

Radiotherapy is a common cancer treatment, but often together with tumor cells, the surrounding normal tissues are damaged as well, which leads to the complications such as skin atrophy, soft tissue fibrosis, desquamation, epithelial ulceration which leads to poor healing of wounds. In this review, our main attention will be paid to the treatment of non-healing wound after radiation therapy. Irradiated wounds are often resistant to conventional treatment modalities and may often require surgical reconstructive intervention. The reconstructive options usually include skin grafts, local and regional flaps. Local flaps may be unreliable, since in some of the cases they are affected by irradiation. However, the complication rate with regional flaps is just as high as that with local flaps, and is not significantly different when analyzed according to the type of reconstructive procedure performed. In addition, such wounds affect not only the physical, but also the mental health of patients and their productivity. Therefore, non-healing wounds represent a significant problem for patients and remain a major challenge in modern medicine. Recently, for the healing of non-healing wound, several novel approaches have been proposed such as using the bone marrow stem cells (BMSC), biologically active dressings, bioengineered skin equivalents and others. Of special interest are bioactive membrane consisting of decellularized human amniotic membrane and BMSC paracrine factors, which may be effectively used for the treatment of non-healing wounds that have developed following the radiotherapy. Despite the positive results achieved in a number of cases, it is early to state that the all of the above methods is an ideal for the treatment of non-healing wounds, since it requires additional experimental and clinical studies for ascertaining positive and negative features.

BONE GRAFTS FOR RECONSTRUCTION OF BONE DEFECTS (REVIEW).

Reconstruction of large size defects of bone is a challenging task. To this date, discussions and controversies on selection of auto-, allo-, xeno- or synthetic grafts continue to take place. Vascularized autologous bone graft is considered as gold standard in reconstruction of large size defects of bone; however an additional surgery is required for obtaining it. Allografts and xenografts possess osteoconductive features, but osteogenesis is less expressed and risk of various infection transmissions is high and may have probability of developing immunological conflict. Main advantages of grafts created from synthetic materials through bioengineering methods are biocompatibility and good bioreabsorption. Despite these features, studies related to the creation of an ideal bone graft continue to take place that should have biomechanical stability, be able to degrade within an appropriate period, exhibit osteoconductive, osteogenic and osteoinductive properties. Nowadays, there is an attempt of creating grafts that contain platelet-rich plasma, growth factors or stem cells for strengthening osteoconduction and osteoinduction of bone grafts. In 2016, we created bioactive bone from decellularized bovine femoral bone and freeze-dried bone marrow stem cell paracrine factors. We hypothesized that freeze-dried BMSC paracrine factors would have ability to strengthen osteoinduction, osteoconduction and osteointegration. Experimental and preliminary clinical investigations indicated that bioactive bone grafts containing freeze-dried BMSC paracrine factors may be used for reconstruction of large size bone defects. Despite acquired positive results, it requires multiple experimental and clinical studies for further improvement of graft.

CHALLENGES AND MANAGEMENT OF CONGENITAL ABDOMINAL WALL DEFECTS (REVIEW).

Management of congenital abdominal wall malformations is still a challenge in paediatric surgery due to visceroabdominal disproportion, large defects of abdominal wall and immature abdominal cavity. Most of the patients treated with primary closure need artificial substitutes like patches or biomaterials for non-permanent abdominal wall closure. Patches represent the source of constant infections and complications like separation of prosthesis from fascia. Removal of these patches and ventral hernia repair is essential afterwards. As for component separation technique, this method helps to restore normal anatomy of anterior abdominal wall, results in good cosmetic appearance, requires only one-stage operation procedure, minimal skin flap advancement and is associated with lower infection risk. Although, while performing component separation technique, perforator branches of epigastric artery (periumbilical perforators) are damaged and puts the vascularization of the skin at the risk. Only pudendal artery branches and intercostal arteries are left to supply the skin with the blood, which from our point of view is insufficient. Accordingly, for successful treatment of congenital abdominal wall defects, further research in order to develop new operation techniques, as well as search for the ideal biomaterials for the closure of the large defects of anterior abdominal wall is essential. These biomaterials should possess unique biological properties that are important for tissue repair, including anti-inflammatory, antimicrobial, antifibrosis, antiscarring, as well as a reasonable cost and low immunogenicity.

BILIARY ATRESIA: CURRENT CONCEPTS AND FUTURE PROSPECTS (REVIEW).

Treatment of biliary atresia is a major challenge in pediatric surgery. Early diagnosis and availability of Kasai procedure with its modern modifications improve outcome of biliary atresia treatment. But Kasai procedure does not fully restore anatomical integrity of biliary tract, because Oddi sphincter is not included in reconstructed system. Constant reflux of intestinal content into the biliary tree is a cause of recurrent cholangitis and change in biliary epithelium that, which is a predisposing factor for cholangiocarcinoma. Various methods have been developed to improve Kasai procedure and prevent the reflux (anti-reflux valve, different enteric conduits, etc.). Many authors used biological grafts made from artery, vein, appendix, urether as well as synthetic materials to restore hepaticocholedochus. Although, neither of these methods were implemented in clinical practice. Nowadays, huge attention is paid to organ and tissue bioengineering. Present advances of tissue bioengineering may assist to create bile duct equivalent, which can be used to restore biliary tract in patients with biliary atresia.

ACELLULAR HUMAN AMNIOTIC MEMBRANE AS A THREE-DIMENSIONAL SCAFFOLD FOR THE TREATMENT OF MUCOGINGIVAL DEFECTS.

This study was conducted to evaluate the usefulness of decellularized and lyophilized extracellular matrix, which was acquired from human amniotic membrane, for surgical closure of the mucogingival defects. Preliminarily, to create a gingival recession defect, silk ligature was applied on the gingival part of the upper incisor in the first (experimental) (n=20) and second (control) (n=20) groups. On the 14th day, the ligature was removed and the damaged gingival tissues were resected. The formed mucogingival defect, in the animals of the first group, was covered with acellular human amniotic three-dimensional scaffold with bone marrow stem cells. Animals with mucogingival defect of the second group were left untreated and served as controls. Unlike the animals from the control group, in animals from the experimental group the mucogingival defect already on the seventh day was completely closed and there was the newly formed epithelial lining, which in shape and color did not differ from the normal. Acellular human amniotic membrane as a three-dimensional scaffold boosts angiogenesis and increases the reparative regeneration of the damaged tissues; and it is well-tolerated by the gingival tissues. Hence, human amniotic membrane might be a suitable alternative to other conventional methods of treating gingival recession.

[Clinical and biochemical analysis of ligature-induced periodontitis in rats].

The most common experimental model of periodontitis is a "ligature" model. However due to the complexity connected with performing on rats, modification of existing model is proposed, which differs by fixture of cotton ligature around the central incisor and not around the second molar. The purpose of research - a comparative evaluation of "peroxide" and modified by us, "ligature" models of periodontitis in rats. 2 series of experiments on 36 white Wistar rats were conducted. The animals were divided into two groups: intact rats (control) and rats with a "peroxide" model of periodontitis, which was reproduced by the addition to the diet of rats overoxidized sunflower oil (5% by weight of the feed), daily, for 45 days. "Ligature" model in rats was reproduced by applying a cotton ligature on the central incisor of the upper jaw for 14 days. Elastase activity, malondialdehyde content and catalase activity in the gums and in the blood serum was measured by biochemical methods. The degree of atrophy of the alveolar bone of the mandible was determined by morphometric method. It is found that in both models of periodontitis in rats, changes in the periodontal tissues and in the organism as a whole, is common for periodontal disease in humans. Clinically apparent inflammation of the periodontal tissues is observed, metabolic disorders in the gums, change of biochemical parameters in serum and progressive decline in the alveolar bone are determined. A comparative analysis of the two models showed that the modified "ligature" model of periodontitis in rats has several advantages over the "peroxide" model: shorter term of modeling, more pronounced clinical inflammation of periodontal tissues and faster resorption of alveolar bone.

Correction of diabetes mellitus by transplanting minimal mass of syngeneic islets into vascularized small intestinal segment.

Transplantation of mature islets into portal vein has been most effective thus far, although attrition of transplanted islets constitutes a major limitation, and alternative approaches are required. We analyzed the mechanisms by which islets engrafted, vascularized and functioned over the long term in the small intestinal submucosa. To determine engraftment, survival and function, 350 syngenic islets were transplanted into either intestinal segments or portal vein of diabetic rats. Islet reorganization, vascularization and function were analyzed by histological analysis, RT-PCR analysis as well as glycemic control over up to 1 year. Transplantation of syngeneic islets in marginal numbers successfully restored normoglycemia in diabetic rats. Transplantation of semi-pure islet preparation did not impair their engraftment, vascularization and function. Islets were morphologically intact and expressed insulin as well as glucagon over the year. Expression of angiogenic genes permitted revascularization of transplanted islets. We identified the expression of transcription factors required for maintenance of beta cells. These studies demonstrated that marginal mass of transplanted islets was sufficient to restore euglycemia in streptozotocin-treated rats. These superior results were obtained despite use of an impure preparation of islets in animals with small intestinal segment. Our findings will help advance new horizons for cell therapy in patients with diabetes.

Ductular reaction at the early terms of common bile duct ligation in the rats.

Ductular reaction (DR) in bile duct ligated rats generally appears from 2nd day after biliary obstruction (BO). However, we show that increased amount of ductular profiles is evident already in 6 hours after BDL. The study aims to explain the origin of such an early DR in response to BO. Male Lewis rats were subjected to common bile duct ligation (CBDL) for 3, 6, 12 and 24 hours and sham operation. Liver samples were studied histologically, immunohistochemically (Ki67, pan-Cytokeratin /AE1 + AE3/ and OV-6) and by immunoblotting analyses. It appeared that number of ductular profiles increase in time-related manner after BO. These ductular profiles are formed by biliary epitheliocyte-like cells; No mitotic activity was revealed. Part of hepatocytes reveals pan-Cytokeratin positivity on 12 and 24 hours after BO. Total cytokeratins content at 24 hours after CBDL was 37% higher in comparison with control data. The significant increase was observed for the cytokeratins with molecular weights: 61, 56 and 40 KDa. Thus, early DR after BDL is mediated by widening of the existed finest biliary ramifications and is not associated with proliferation activities. This DR is accompanied by differentiation of hepatocytes toward bile duct-like cells.

Bone marrow-derived mesenchymal stem cell plasticity and their application perspectives.

The aim of this review is to summarize recent developments in research on the characteristics of bone marrow-derived mesenchymal stem cell plasticity. Stem cells are uncommitted entities capable of both self-renewal and differentiation into multiple cell lineages. In general, there are certain types of stem cell populations that are identified from embryonic and postnatal tissues. Embryonic stem cells are derived from mammalian blastocytes and theoretically have the ability to generate differentiated cell types arising from the three germ layers: mesoderm, ectoderm and endoderm. In contrast, postnatal stem cells are thought to be tissue specific, committed precursors capable of developing into a restricted number of cell lineages. Bone marrow stromal stem cells (BMSSCs), also known as mesenchymal stem cells, have been identified as a population of organized hierarchical postnatal stem cells with the potential to differentiate into osteoblasts, chondrocytes, adipocytes, cardiomyocytes, myoblasts and neural cells. Recently, studies on the plasticity of BMSSCs challenge the traditional dogma that the differentiation and commitment of postnatal stem cells are limited to cell populations resident in their local environment. Current boneregenerative techniques, such as autologous bone grafting, allografts and alloplastic materials, have limitations that hinder their use in a wider range of clinical conditions. Hence, the development of improved methods, such as BMSSC-mediated bone regeneration, is necessary for achieving future viable therapeutic alternatives.

Anti-hepato-cytotoxic serum treatment results in acute liver failure.

Only few conditions in medicine are more dramatic or more devastating than acute liver failure, severe liver-cell dysfunction strikes previously well people suddenly, and many of them die. Acute liver failure (ALF) is broad term that refers to both fulminant hepatic failure (FHF) and sub-fulminant hepatic failure (or late-onset hepatic failure). FHF may result from a variety of hepatic disease processes. Viral hepatitis and hepatotoxic drugs are the most common factors inducing severe illness with the loss of hepatic function. Elevated serum concentrations of bacterial endotoxin, tumor necrosis factor-a, and interleukin-1 and interleukin-6 have been found in FHF, but the specific roles of these inflammatory factors are unclear. Numerous causes of FHF exist, but viral hepatitis and acetaminophen overdoses are the most common. The cause remains unknown in as many as 15% of patients. The aim of the study was the evaluation of the clinical course and complications of acute liver failure in experiment, We created an experimental model using hepatotoxic substance (CCL4), which causes centrilobular lesions in liver parenchyma. Nowadays, total or subtotal liver transplantation supposed to be an effective method. The restrictions of this method includes: 1. Donor organ deficit, 2. Post-operative complications, 3. Lifetime immunosuppression, 4. Expensiveness of the method. Our method proposes treatment by anti-hepato-cytotoxic serum, which induces stimulation of hepatocyte regeneration. It consists of vasoactive mediators (nitric oxide, carbon monoxide), activated complement cascade components, immunomodulators, regenerative hepatocytes, membrano-protectors and hepato-stimulator medications.

[Wounds treatment by the transplantation of the fibroblasts and stem cells on collagenic matrix].

During many decades the development of effective methods of wounds treatment has been and still remains to be one of the most actual problems of surgery. Interest and constant attention to wounds speaks first of all that simultaneously with development of medicine, cellular and molecular biology, molecular genetics and immunology consideration of wounds processing is constantly vary. New prospects and opportunities of effective treatment of wounds are opening. We develop a new original method of treatment full-thickness wounds by a method of transplantation fibroblasts and stem cells on the basis of collagenic matrix. The presented method of treatment of full-thickness wounds provides the most perfect realization of stimulating action of cultures of cells on the processes of regeneration of tissue. Application of fibroblasts and stem cells on the basis of collagenic matrix promotes restoration of normal structure of a skin and allows reducing terms of healing considerably. Stem cells are integrated into three-dimensional tissue structures of an organism and promote histotopically to restoration of defects of a skin covering. Here it is necessary to note, that transplanted skin fibroblasts synthesize and allocate in an environment a plenty of biologically active substances among which distinguish epidermal growth factor (EGF), fibroblast growth factor (FGF), transforming growth factor (TGF), keratinocyte growth factor (KGF), and also various components of extracellular matrix.

[Treatment of thrombophlebitis by the method of the transplantation of the endothelial cells].

The end XX of century was marked by introduction into the clinical practice of the methods of cellular therapy. Intensive studies on its application for treating the whole series of diseases are conducted. Thrombophlebitis is not an exception in spite of the already existing effective surgical and conservative methods of its treatment. On the rabbits we produced experiments on the treatment of thrombophlebitis of "aseptic" and infectious etiology. The results of complex treatment with the use of autologous vascular endothelial cells were studied. The damaged wall of vein under the conditions of the "aseptic" model of thrombophlebitis, with conducting active complex therapy with the start of antibiotics and trombolitic means is completely covered with endothelium, and only to the place where the dust devils were attached to the walls of vein, defects remain. In these places the wall of vein gradually is extended and undergoes scarring, and the intact sections of vein around the defect are hypertrophied and then they undergo dilatation, being adapted thus to the new conditions of functioning. The transplanted endothelial vascular cells not only modify the process of remodulation of the damaged vein and thus they contribute to averting the dilation of its wall and expansion of scar, but also contribute to the retention of the thickness of the wall of vein. Calculations showed that in the case of "aseptic" etiology the processes of thrombogenesis and treating thrombophlebitis continue more rapidly than in the case of the infectious etiology. The comparison of traditional method of the treatment of thrombophlebitis with the complex (with the application of auto of endothelial cells) showed that the latter is more effective.

[New solution for cells and organs tissue conservation].

One of the major problems in organ and tissue transplantation is the conservation of donor's material from the moment of its impressments till its grafting in the recipient's organism. The new direction in transplantation is a method of liver tissue micro-fragments transplantation in bio-container Kakabadze, which was elaborated at the Department of Clinical Anatomy of Georgian State Medical Academy. In this work the results of investigation of hepatocytes' viability in micro-fragments were studied. The micro-fragments were placed in different medias, including the one elaborated by us on the bases of natural sugar-containing preservative. The decrease of percentage of viable hepatocytes in dependence of preservation time in different media was investigated. In all cases the dependence can be approximated by exponential function. On the bases of experimental data semi-empirical mathematical model of processes taking place in liver tissue micro-fragments during their preservation was created. Two parameters are introduced: one of them A depends on the method of micro-dissection, and the other T (1/2) is characteristic of the media and represents the time, in which the percentage of viable hepatocytes halves. The percentage of nonviable hepatocytes and also the percentage hepatocytes, which were in condition of apoptosis, were investigated. The investigations had shown that in all cases 50% barrier did not exceed 17 hours. This barrier in solution that is elaborated by us reached 46, 4 hours. Besides, if we assume, that the half of hepatocytes, which were in apoptosis condition, will become viable after transplantation, then the barrier will run up to 125 hours. The investigations of intra-cell glycogen showed that in all medias we had used, resources of glycogen were exhausted during one hour. In the case of solution elaborated by us glycogen was maintained in cells during 7-8 days.

[Treatment of obstruction of extrahepatic biliary pathways by antireflux, bilio-cholecystic (cystico) enteroanastomosis methods].

The main target of our investigations was the development of antireflux, bilio-cholecysto (cystico) enteral anastomosis method for the surgical treatment of extrahepatic biliary duct obstruction. We were using the cholecystic duct spiral valve (Lutkens valve, Haister valve) as the antireflux structure. In this case the bile drains into the biliary cyst not through the cholecystic duct but through the extrahepatic biliary duct - the bilio-cholecystic anastomosis. Such an interposition of cholecystic and spiral valves promotes inhibition of chemical reflux between extrahepatic ducts and gastrointestinal tract, from digestive tract into the cholecystic and intrahepatic biliary tracts. Method developed and tested by us involves creation of blio-cholecystic (cystico) entero anastomosis, namely creation of biliary duct-cholecystic (cystico)-duodenoanastomosis. 3 successful experimental operations have been performed using the above presented approach. Sutures were taken of on the seventh day, animals were housed under investigations for 10-14 days, faecal masses had normal appearance.

Prospect of using decellularized human placenta and cow placentome for creation of new organs: targeting the liver (part I: anatomic study).

INTRODUCTION: This paper presents anatomic studies of decellularized human placenta and cow placentome and proves that there is a possibility to create a scaffold using the natural microvascular structure for growing organs and tissues. MATERIALS AND METHODS: The anatomic studies were conducted on 20 full-term placentas from human donors, and placentomes collected from 8 cows. Before the anatomic studies of human placenta and cow placentome, decellularization was conducted. For visualization of vessels, 50% Latex in water (Nairit L3) through the umbilical cord artery and vein was injected. Corrosion casts were also prepared. RESULTS: An important feature in the transplantation of microfragments of the liver tissue is the blood supply system of the piled chorion, which consists of the main vascular trunks, and perivascular and superficial capillary network. Conditionally, based on the degree of difficulty, there are several types of grouping of the capillaries in terminal pile: simple capillary knot, coiled capillary knot, and complexly organized tangle-shaped capillary network with the richly anastomosing crimped microvessels. A similar pattern was observed in the terminal pile of the placentomes of the cow. For the creation of the auxiliary liver and connection of it into the systemic circulation of the recipient, we can use this exclusiveness of the angioarchitechtonics. CONCLUSIONS: Anatomic studies demonstrated that decellularized human placenta, as well as cow placentome, can be used as a scaffold for growth of organs and tissues in vitro and in vivo.

The intracorporeal autoorganic biofilter of portal blood in portal hypertension surgery.

BACKGROUND/AIMS: The authors present the new surgical treatment method for portal hypertension by means of intracorporeal autoorganic biofilter of portal blood at the portosystemic shunt pathway. The hepatized spleen is used as the organic biofilter of portal blood. METHODOLOGY: The experiments were carried out on 20 mongrel dogs, both sexes, 18-20 kg of body weight. The animals were divided into the four equal groups. The comparative evaluation of portal hypertension treatment efficiency by means of several vascular portosystemic shunts were performed after the portal hypertension modeling. On the animals of groups I and II, the mesenterico-caval and splenorenal shunts were performed, respectively. The hepatized autospleen was involved in the portosystemic shunt pathway in the animals of group III. The animals of group IV served as controls. RESULTS: The reduction in perfusional pressure of the blood which flows to the liver led to damage of the organ's functional possibilities, significant disturbances to the hemodynamics and reduction of the liver detoxification possibilities, respectively, for several portocaval shunt creations during the portal hypertension model. On the other hand, the undetoxificated portal blood entrance into the system blood flow via the created shunt over the liver increased. CONCLUSIONS: The hepatized autospleen insertion into the portosystemic bloodflow gave us the opportunity to perform the dosage passing of portal blood into the systemic bloodflow and to maintain the pressure of the portal blood, which flows to the liver. Moreover, the hepatized autospleen has shown such specific liver functions as glucogenesis, albumin synthesis and others.

The experimental distention of dissected bile duct for the restoration of its continuity in dogs using a device of own construction.

PURPOSE: The segmental resection of constricted bile duct and end-to-end biliary anastomosis could be an attractive alternative in the treatment of benign biliary tract stricture. The aim of this study was to restore the anatomical integrity of the hepatic-common bile duct after an artificially produced defect while maintaining the large duodenal papilla, using microsurgical technique. MATERIAL AND METHODS: The experiments were carried out on 25 mongrel dogs. The common bile duct was ligated in all of the animals during laparotomy, as a model of bile duct obstruction in humans. Relaparotomy was performed 3 days after the initial operation. The segment of bile duct, 4 cm in length was resected together with the ligature. The continuous bile flow into the duodenum was assured by a polyvinyl catheter introduced into both ends of dissected bile duct. The proximal end of the hepatic-common bile duct was fixed to a device constructed by us for the distention of the bile duct (DDBD). The anterior part of the device was exteriorized through a separate fistula and fixed to the abdominal wall. The hepatic-common bile duct distention was gradually continued during 18 days, by pulling out the mobile part of the device. After 18 days the device was removed and the distended proximal end of the hepatic-common bile duct was anastomosed end-to-end with its distal end. The sequels of this procedure were observed for up to 6 months. RESULTS: The hepatic-common bile duct was distended 4 cm within 18 days. The histopathological examination has shown partial damage of the duct framework due to the distention and tension. However the patency of the duct was preserved and the recovery of normal structures were observed after the device was removed and anastomosis fashioned. CONCLUSION: This method, developed by us, offers the possibility of restoring the integrity of injured extrahepatic bile ducts, allowing effective treatment of benign biliary strictures.