A novel biodegradable biliary stent in the normal duct hepaticojejunal anastomosis: an 18-month follow-up in a large animal model.

Creating a well-functioning hepaticojejunostomy (HJ) anastomosis with nondilated bile ducts remains a challenge. Our aim was to study the use in a large animal model of a novel, braided polylactide barium sulfate biodegradable biliary stent (BDBS) without external connection and with no need for later removal. Fifty swine were randomly operated on for Roux-Y HJ with or without BDBS in the anastomosis, and followed up (dynamic biligraphy, x-ray, serum determinations, anastomosis inner diameter, and histology) for 1.5, 3, 6, 12, and 18 months. During the follow-up, one nonstented animal died because of anastomotic leakage. In x-ray BDBS was seen in place until 1.5 months in all of the stented animals. In the nonstented animals HJ anastomosis inner diameter was decreased at 18 months [6.3 (5.0-7.0) mm vs 7.4 (7.0-9.0) mm, p = 0.05] and liver clearance reduced at 12 and 18 months compared to stented animals. Serum liver values and liver and bile duct histology did not differ between the groups. We conclude that this novel BDBS is easy to insert into the HJ anastomosis with nondilated ducts. It is nontoxic, dissolves safely, and may be associated with a larger and better draining anastomosis at 18-month follow-up. These results encourage us to proceed to clinical studies.

Intraoperative localization of parathyroid glands with gamma counter probe in primary hyperparathyroidism: a prospective study.

BACKGROUND: Technetium 99m-sestamibi imaging might be the best method to localize abnormal parathyroid glands. No studies to date have compared preoperative imaging and intraoperative gamma probe localization in patients with primary hyperparathyroidism. STUDY DESIGN: This prospective study included 20 arbitrarily selected patients with primary hyperparathyroidism, verified by elevated serum ionized calcium and intact parathyroid hormone concentrations and low serum phosphatase level. Each patient underwent both preoperative imaging study of the parathyroid glands with technetium 99m-sestamibi (dose 740MBq) and intraoperative localization with a handheld gamma probe. Full collar exploration served as the gold standard. RESULTS: Hypercalcemia and hypophosphatemia normalized in each patient. A single parathyroid adenoma was confirmed histologically in 16 and hyperplasia (4 abnormal glands) in 4 patients. None of the patients had multiple adenomas. The sensitivity of the preoperative scan was 81% (13 of 16 patients) in adenoma patients and 100% (4 of 4 patients) in hyperplasia. The corresponding specificity was 88% and 100%. Intraoperatively only 8 of 16 adenomas were correctly detected (sensitivity 50%), and none of the hyperplastic glands were correctly detected. CONCLUSIONS: In unselected patients with primary hyperparathyroidism, preoperative technetium 99m-sestamibi imaging is more accurate than intraoperative gamma probe detection in localizing abnormal parathyroid glands.