External metallic circle in microsurgical anastomosis of common bile duct Mesut Tez, M.D. a,d, *, Mehmet Keskek, M.D. b ,O ¨ mer O ¨ zkan, M.D. c , Sebat Karamursel, M.D. c a Department of Surgical Oncology, Ankara University Faculty of Medicine, Ankara 06100, Turkey b Department of General Surgery, Hacettepe University Faculty of Medicine, Ankara06100, Turkey c Department of Plastic and Reconstructive Surgery, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey d Emek-S ¸enyuva mahallesi Mertebe sokak 23/2, Ankara 06500, Turkey Manuscript received January 26, 2001; revised manuscript May 14, 2001 Abstract Background: Biliary stricture development is one of the most serious problems following biliary tract surgery. Here, we present a new technique for biliary tract reconstruction with an external metallic circle, and the results of this new technique in a rat model. Methods: Twelve male Sprague-Dawley rats (250 to 300 g) were divided into two groups. After transection of the bile duct, standard bile duct reconstruction (without the metallic circle) was performed in group 1 and reconstruction with the external metallic (silver) circle was performed in group 2. At the end of the fourth month, clinical, laboratory biochemical, and histopathologic parameters were compared between the groups. Results: Serum concentrations of alkaline phosphatase (ALP) and operation time were higher in group 1 than in group 2. Differences were statistically significant. In histopathologic examination, biliary duct stricture was seen in group 1. Foreign body reaction and fibrosis in the bile duct wall were seen in group 2. Conclusion: An external metallic circle prevents development of biliary stricture after primary end-to-end bile duct anastomosis in this rat model. © 2001 Excerpta Medica, Inc. All rights reserved. Keywords: External mettalic circle; Bile duct anastomosis; Biliary stricture The end-to-end choledochocholedochostomy is performed for traumatologic and iatrogenic bile duct injuries and in liver transplantation. Biliary tract stricture and fistulas are seen frequently after choledochocholedochostomy [1–3]. A great percentage of these patients present to hospital with serious sclerosing cholangitis and hepatic abcess formation [4]. Still, there is no consensus about the use of T tubes and internal stents for prevention of biliary strictures. However, leakage at the exit site, dislodgement, biliary obstruction, and cholangitis are not uncommonly encountered as a result of T-tube usage. Biliary strictures develop especially in the early months and years after biliary tract operations [5]. Mucosal scarring and contracture play the most important roles in biliary stricture development [5]. External metallic circle had been used for the microvas- cular anastomosis in rats by Karamursel et al [6]. The anastomosis patency was higher than conventional primary anastomosis with this device. The aim of our study was to examine usage of the external metallic circle in primary bile duct anastomosis. Materials and methods Animals Twelve male Sprague-Dawley rats (Laboratory of Ex- perimental Animals, Hacettepe University Faculty of Med- icine, Ankara, Turkey) weighing 250 to 300 g were used. The animals housed under environmentally controlled con- ditions at 21  2°C and 30% to 70% relative humidity with a 12-hour dark and 12-hour light cycle. Free access to water and standard laboratory food was provided. Before the op- erations, the rats were fasted overnight and were only al- lowed free access to water. All of the procedures in this study were reviewed and approved by the Ethical Commit- * Corresponding author. Tel.: +90-312-2153834; fax: +90-312- 3091885. E-mail address: mtez@hacettepe.edu.tr The American Journal of Surgery 182 (2001) 130 –133 0002-9610/01/$ – see front matter © 2001 Excerpta Medica, Inc. All rights reserved. PII: S0002-9610(01)00680-8