Mehmet Hatip ADIGÜZEL, Güvenç DİNER, Recep ÇAĞLAR
Journal of Surgery and Medicine - 2026;10(7):0-0
Background/Aim: Biliary tract injuries with tissue loss remain challenging in hepatobiliary surgery. Primary repair, bilioenteric anastomosis, and various graft materials have been used; however, each approach has limitations, including stenosis, infection, and foreign-body reaction. This study aimed to evaluate the feasibility and effectiveness of an autogenous pediculated gallbladder flap for reconstructing choledochal wall defects in an experimental ovine model. Methods: Fourteen Awassi sheep underwent surgical creation of a 2-3 mm full-thickness anterior choledochal wall defect located 1 cm distal to the cystic duct junction. The defect was repaired using an autogenous pediculated gallbladder flap without biliary stenting. Blood samples were obtained preoperatively and on postoperative days 7 and 14 to measure total bilirubin, AST, ALT, and ALP. Hepatobiliary scintigraphy with Tc-99m HIDA was performed on postoperative day 14. On day 30, surviving animals underwent relaparotomy and histopathological examination. Results: Three animals died early postoperatively due to anesthesia-related cardiopulmonary complications and were excluded from the analysis. Eleven animals completed follow-up. Total bilirubin and ALP did not differ significantly across time points. AST and ALT increased on postoperative day 7 compared with baseline and returned to baseline by postoperative day 14. Scintigraphy showed normal bile transit without leakage, stenosis, or proximal dilatation. Macroscopic and histopathological evaluation confirmed flap viability and complete epithelialization. Conclusion: Reconstruction of choledochal wall defects using an autogenous pediculated gallbladder flap appears safe and physiologically advantageous in this ovine model. Preserved mucosa, intact vascularity, and autogenous tissue characteristics support its potential as an alternative to synthetic materials or bilioenteric reconstruction.
