RESUMO
Las lesiones quirúrgicas de la vía biliar fina, continúan siendo un dilema. Los procedimientos no invasivos requieren la continuidad de la vía biliar para poder colocarse. En este trabajo intentamos comprobar si el reemplazo de la vía biliar por un tubo de silicona, es posible. A 9 cerdos de 18-20 kg se les reemplazó la vía biliar principal por un tubo de 100% silicona. Se les realizó análisis de laboratorio, colangiorresonancia, ecografía, colangiografía y manometría intraoperatorias con examen de anatomía patológica a 60 días de la cirugía inicial. Los 9 cerdos sobrevivieron a la cirugía de reemplazo de la vía biliar por un tubo de silicona más de 60 días sin evidencia de colestasis significativa por laboratorio. Todos los cerdos fueron reintervenidos, y mostraron dilatación del colédoco y conductos hepáticos duplicando o triplicando por lo menos, su tamaño inicial sin dilatarse el resto de la vía biliar intrahepática, ni presentar signos ni laboratorio significativo de colestasis. Nuestro estudio puede entenderse como una intención inicial de encontrar la prótesis y la situación ideal para poder reemplazar la vía biliar extrahepática fina, en situación quirúrgica de emergencia o paliativa sin posibilidad de stent. El reemplazo por el tubo de silicona en nuestra experiencia resultó positivo con esta intención, manteniéndose permeable, sin generar fibrosis permitiendo una posterior cirugía definitiva, sin perjudicar el estado nutricional
Surgery of the biliary tract is complex, and its volume has increased with iatrogenic injuries and living donor transplantation. The aim of this study was to analyze if the common duct can be temporarily replaced. We used nine 18-20 kg pigs. They were operated on, and their bile duct was replaced by a 100% silicone tube. All pigs underwent laboratory tests, magnetic resonance imaging, intraoperative ultrasound, cholangiography and biliar manometry with pathological biopsy examination within 60 days from the initial surgery. All pigs survived the first surgery over 60 days without laboratory evidence of evident cholestasis. Nine pigs were re-operated on at 60 days showing dilated common bile duct and hepatic ducts doubling its original size without dilating the intrahepatic bile ducts. There were no clinical, relevant laboratory or biopsy signs showing cholestasis. This experience represents the initial intention to find an optimal situation and prosthesis for replacement of the thin biliary tract, in surgical emergencies or palliative situations. The silicon tube, is a positive answer that remains permeable. A non-fibrotic reaction was found that allows a posterior definitive procedure, maintaining a good nutritional status
Assuntos
Animais , Coledocostomia/métodos , Ductos Biliares/cirurgia , Implantação de Prótese/métodos , Ducto Colédoco , Modelos Animais de Doenças , Ductos Biliares/lesões , Silicones , Suínos/cirurgiaRESUMO
Surgery of the biliary tract is complex, and its volume has increased with iatrogenic injuries and living donor transplantation. The aim of this study was to analyze if the common duct can be temporarily replaced. We used nine 18-20 kg pigs. They were operated on, and their bile duct was replaced by a 100% silicone tube. All pigs underwent laboratory tests, magnetic resonance imaging, intraoperative ultrasound, cholangiography and biliar manometry with pathological biopsy examination within 60 days from the initial surgery. All pigs survived the first surgery over 60 days without laboratory evidence of evident cholestasis. Nine pigs were re-operated on at 60 days showing dilated common bile duct and hepatic ducts doubling its original size without dilating the intrahepatic bile ducts. There were no clinical, relevant laboratory or biopsy signs showing cholestasis. This experience represents the initial intention to find an optimal situation and prosthesis for replacement of the thin biliary tract, in surgical emergencies or palliative situations. The silicon tube, is a positive answer that remains permeable. A non-fibrotic reaction was found that allows a posterior definitive procedure, maintaining a good nutritional status.
