Knotless choledochorraphy with barbed suture, safe and feasible

Area of Science:

• Surgical Innovation
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Laparoscopic common bile duct exploration (LCBDE) is the preferred method for complex bile duct stones.
• Primary closure of the common bile duct is superior to T-tube drainage.
• Existing techniques for primary closure require optimization.

Purpose of the Study:

• To evaluate the safety and feasibility of using a continuous unidirectional barbed suture (V-Loc 90) for primary common bile duct closure during LCBDE.

Main Methods:

• A single surgeon performed LCBDE on 54 patients between July 2012 and July 2014.
• Fifty patients underwent primary common bile duct closure using a knotless unidirectional barbed 3-0 V-Loc 90 suture without knot tying.
• Perioperative outcomes and 30-day complications were recorded.

Main Results:

• The procedure was successfully completed in all 50 patients with primary closure, with no intraoperative complications.
• No bile leaks or other postoperative complications (infection, reintervention, death) were observed in the 50 patients.
• The V-Loc 90 suture facilitated knotless closure.

Conclusions:

• Knotless unidirectional barbed suture (V-Loc 90) is a safe, feasible, and effective option for primary common bile duct closure in LCBDE.
• The observed biliary leak rate is acceptably low and aligns with existing literature.
• Further clinical trials are warranted to confirm these initial findings.