Related Surgical Information

Bile Duct Cannulation with Duodenal Return Description

Anesthetic: Isoflurane, Analgesic: Buprenorphine (IP)

Basic Surgical Procedure Description:

An anesthetized animal is surgically prepared and draped. A 2.5-cm ventral midline skin and abdominal muscle wall incision is made with a cranial terminus near the xiphoid process. The liver is gently retracted to reveal the bile duct. Using low magnification of a dissecting scope an area is identified for cannulation below the bifurcation from the liver lobes. After placing sutures a small incision is made into the lumen of the bile duct with spring scissors. The tippet of the bile duct cannula is inserted into the lumen and advance to the first silicon bead. Bile is observed flowing into the cannula and the internalized tip location is confirmed to be below the bifurcation of the bile duct. The cannula is secured in place with suture.

A purse string suture is made in the duodenum in an area of minimal vasculature. The tippet of the duodenal cannula is inserted via a small incision to the first silicon bead and secured in place. Patency is verified by injecting a small volume of saline into the duodenum. Both cannulas are exteriorized through a hole in the abdominal wall to a point between the shoulder blades and positioned so that the bile duct cannula is caudal to the duodenal cannula. Abdominal musculature is closed with absorbable suture. The abdominal skin incision and sub scapular exteriorization sites are closed with stainless steel wound clips. A 23 gauge "U" tube connects the two cannulas. Cannulas are taped together for security and the patient is allowed to recover from anesthesia in a heated cage.

Cannulas:

Bile duct cannula material consists of a length of sterile silicone rubber with a 10mm microrenethane tip. The access port consists of a 25mm length of PE50 tubing (0.023" ID). Duodenal cannula material consists of a length of sterile silicone rubber with a 25mm access port. The two access ports are connected with sterile 23 gauge stainless steel tubing. Fill volumes of each cannula is 75ul.

Quality Control:

Patency is verified by ensuring bile readily flows from the bile duct cannula and that fluid is readily injected into the duodenal cannula on the morning of shipment. To increase the longevity of this preparation the duodenal cannula should be flushed every two to three days with 0.2-0.5mL sterile distilled water. Never flush the bile duct cannula.

Expectations:

Surgery occurs within a day or two of shipment. Investigators should expect the bile duct preparation to be patent upon arrival and last for roughly one week post receipt. Bile duct cannulations are not stable for long periods of time and should be used as close to the date of receipt as possible.