Common bile duct reconstruction using vascularized support of a free amnion graft

ABSTRACT

Benign bile duct stricture is common in surgical practice. The complications of late stricture formation and biliary sepsis still occur in bile duct reconstruction. Many biologic and artificial materials have been used to replace the damaged bile duct to avoid bilio-enteric anastomosis, which bypasses the biliary sphincter mechanism. Non satisfactory biliary replacement material has yet been found, until the use of human amnion as a free graft or supported by vascularized flap. Non circumferential bile duct loss appeared to be satisfactorly repaired using amnion. However, circumferential duct loss was not adequately repaired with amnion graft only, so we used in our work the vascularized peritoneomuscular flap depending on one of the phrenic vessels to support the amnion graft, this improved much the results: