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    Biliary tract reconstruction with autologous rectus sheath graft - An experimental study
    (H G E Update Medical Publishing S A, 2005) Aydın, Metin; Bakır, Bahtiyar; Kösem, Mustafa; Kisli, Erol; Gençcelep, Musa
    Background/Aims: Common bile duct injuries which cause significant morbidity and mortality are one of the most serious complications of cholecystectomies. They can be repaired by various approaches. Methodology: We used an autologous graft obtained from the posterior sheath of the rectus muscle in biliary tract reconstruction for common bile duct defect. This experimental study was carried out on six dogs. A tissue fragment was excised from the posterior sheath of the rectus muscle together with the fascia transversalis and peritoneum. A channel from the fascial graft was formed around a T-tube. The autologous rectus sheath graft was sutured to the common bile duct as a segmental conduit graft. Afterwards, blood biochemistry values and liver histopathology were investigated. Dogs were studied by T-tube cholangiography 4 months postoperatively just prior to removing the T-tube and again 2 months later at relaparotomy. The hepatic parenchyma, intra- and extrahepatic bile ducts were detected by ultrasonography during the last 2 months, one time in fifteen days. Results: There was no anastomotic insufficiency. The fascial graft gained an appearance similar to bile duct in dogs. Postoperatively, no change in blood biochemical parameters was observed, and in the preoperative and postoperative periods no histopathological change in the liver was Conclusions: These findings indicate that the use of an autologous fascial graft to repair common bile duct injuries as a conduit graft for segmental bile duct loss may be a feasible and alternative method of treatment.
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    PREVENTION OF WRAP DISRUPTION AFTER ANTIREFLUX SURGERY: AN EXPERIMENTAL STUDY
    (Nobel Ilac, 2015) İlçe, Zekeriya; Özaydın, İsmet; İskender, Abdülkadir; Aydın, Metin; Kisli, Erol; Gençcelep, Musa
    Objective: The worst complication after a fundoplication is the disruption of the fundic wrap which is the main cause of recurrent gastro-esophageal reflux. The purpose of this experimental study is to seek for an alternative technique to prevent wrap-breakdown. Material and Method: The experiments were carried out on thirty canine subjects those were randomly allocated into 3 groups for performance of a Nissen procedure. Silk sutures were used for construction of the fundic wrap in Group I, silk sutures and fibrin glue were used in Group II and only fibrin glue was used in Group III for the same purpose. Operation durations were noted as minutes. The break-down force of the fundic wrap was measured and recorded. The results were recorded as kg and statistical examinations were performed by SPSS 13.0 statistical software program. The intergroup comparisons were performed with Kruskal-Wallis and Mann-Whitney U tests. p was significant at <0.05 Results: No post-operative complications were observed and all the animals survived until the post-operative 2nd month when they were euthanized and the wrap break-down forces were determined. The break-down force was 11.2 kg in Group I, 17.3 kg in Group II, and 11.5 kg in Group III. The difference between group I and II, with group III was statistically significant (p<0.05). But group I and III was not statistically significant (p>0.05). Operation times were 47.9 in Group I, 53.2 in Group II and 28.38 minutes in Group III. Operation times were significantly longer in Group II than in Group I and III (p<0.05), and significantly shorter in Group III than in Groups I and II (p<0.05). Conclusion: We believe that, application of the fibrin glue together with the conventional suturing technique in construction of the fundoplication may prevent wrap-breakdown after the Nissen antireflux procedure.