RESUMO
Surgical repair of hilar biliary injuries is difficult and remains a challenge which requires specific skills and experience. The aim of this study is to improve the outcome of surgical repair of type IV Bismuth BDI in situations in which there is extensive tissue loss by introducing the novel technique of isolated L-shaped tube of biliary reconstruction. This technique is tested in a live animal experimental study. Twenty mongrel dogs underwent biliary reconstruction using antral tube harvested and completely separated from the greater curvature of the stomach with its blood supply based upon right gastroepiploic vessels. The tube was anastmosed to LHD by end to end anastmosis then to RHD by end to side anastmosis then to duodenum. Postoperative mortality, morbidity, liver functions, gross and microscopic histologic pictures were assessed. One dog died from anaesthetic complication and another three dogs died due to abdominal sepsis. Sixteen dogs survived the procedure and showed uneventful course with no cholestasis. The mean internal diameter at the site of anastmosis with pedicled antral tube was 2.1 mm [range 2-3] for RHD, 3.2 mm [range 3-5] for LHD and 6.5 mm [range 5-7.5] for duodenum. Histologically, anastomotic sites showed good evidence of healing. In mongrel dogs surgical repair of Bismuth type IV bile duct injuries using isolated antral inverted L-shaped tube with a vzscularized pedicle is feasible and produces satisfactory results regarding biliary complications, anastomotic circumference and histological evidence of healing