A tissue-engineered artificial bile duct grown to resemble the native bile duct in a porcine model

The aim of this project was to fabricate an artificial bile duct as a new potential treatment for biliary diseases.This project sought to evaluate a novel approach for repairing common bile duct injuries with a biosynthetic graft without an intestinal bypass. SUMMARY AIM:The reference standard technique for the reconstruction of the extrahepatic biliary tree is Roux-en-Y hepaticojejunostomy.This procedure is not devoid of complications and may not be feasible in some patients.This project sought to evaluate a novel approach for repairing common bile duct injuries with a biosynthetic graft.This allows the reconstruction of the anatomy without an intestinal bypass.Methods: Study subjects were 5 pigs.Each animal underwent a biliary injury, using an open approach.A graft of a synthetic bioabsorbable polymer scaffold made of PHEA-PLA+PCL was used to repair the defect with absorbable sutures.Weekly liver function tests were performed.Animals were sacrificed at months three and six.Subsequently, gross and histological examinations were performed.Results: There were no fistulas or abdominal collections.The polymer scaffold and, more specifically, the planar-shaped scaffold led to a regeneration of the bile duct.The histological examination showed lymphomonocytic infiltrate and neovascularization.In two animals, regeneration failed due to the collapse of the scaffold. Conclusion:The use of polymeric scaffolds for the repair of bile duct injury may represent a new frontier in hepatobiliopancreatic surgery.On the contrary, synthetic polymers can be produced on a large scale with controlled properties (resistance, degradation rate, porosity).Synthetic polymers have several advantages: the possibility of modulating the chemical, physical and mechanical properties, forming copolymers or mixtures with different monomers in the same polymer; porosity like that of natural tissues; presence of free chemical groups that can be used to incorporate other substances (e.g., heparin, antibiotics and growth factors) for direct bonding 46 .