Structural and mechanical remodelling of the common bile duct after obstruction

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Abstract
Biliary obstruction in man, most often caused by cholelithiasis, induces remodelling of the bile ducts. Obstruction‐induced structural remodelling of the common bile duct (CBD) has been previously described. The mechanical changes that accompany the structural remodelling, however, have not been studied in detail. The aim of this study is to quantify the structural and mechanical changes in the CBD at different time intervals after acute obstruction. The CBD was ligated in the pig, near the duodenum, and studied after 3 h, 12 h, 2 days, 8 days and 32 days (n=5 in each group). One additional animal in each group was sham‐operated. At each scheduled time, the CBD was mechanically tested in vitro with a computer‐controlled volume infusion system to study the pressure–volume relationship of the CBD segment. A video camera provided simultaneous measurements of the outer dimensions of the CBD at the various pressures. The diameter and wall thickness of the CBD increased about three‐fold in the 32‐day group compared to the sham group (P < 0.001). The circumferential stress–strain relationship differed between groups (P < 0.001); it was shifted to the right, indicating softening, in the 3‐h, 12‐h, and 2‐day groups and to the left, indicating stiffening, in the 8‐day and 32‐day group, compared to the sham group. The longitudinal stress–strain curves were all shifted to the left of the circumferential stress–strain curves (P < 0.05). The collagen area increased during obstruction (P < 0.001) but no correlation between the size of the collagen area and the biomechanical parameters was found. A practical implication of the present study serves as a warning to surgeons. A reduction in the wall stiffness in the first several days of obstruction along with an increased duct diameter and a decreased wall thickness suggest that operative procedures such as suturing, anastomosis and procedures related to ERCP must be performed with special care to avoid damage to the CBD.