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Primary closure of choledochotomy using CO2 laser: comparison with suture closure
C C Vanterpool1, M E Gales, S Bolton
1North Oakland Medical Center, Pontiac General Hospital Division, Department of General Surgery, Michigan 48341-1651.
Lasers in Surgery and Medicine
|January 1, 1993
Summary
CO2 laser welding for common bile duct (CBD) closure showed no statistical differences compared to sutures but had a clinically significant 33% dehiscence rate. Further optimization is needed before clinical use.
Area of Science:
- Surgical Innovation
- Gastroenterology
- Biomedical Engineering
Background:
- Suture closure is the standard for common bile duct (CBD) repair.
- Laser welding offers a potential alternative for tissue approximation.
Purpose of the Study:
- To compare the efficacy and safety of CO2 laser welding versus traditional suture closure for the common bile duct (CBD).
Main Methods:
- A 12 mm linear choledochotomy was created and closed in 24 mongrel dogs.
- One group (n=12) underwent CO2 laser welding (5.0 w/cm2 for 120 sec).
- The control group (n=12) had CBD closure using 5/0 Vicryl interrupted stitches.
Main Results:
- No statistical differences were observed in liver function tests, stenosis, or dehiscence between laser welding and suture groups.
- A clinically significant 33% (4/12) incidence of dehiscence and mortality occurred in the laser welding group.
- Gross and histologic evaluations were performed at six weeks post-procedure.
Conclusions:
- CO2 laser welding for CBD closure requires significant optimization of tensile strength.
- Current results are preliminary and do not support clinical recommendation due to high complication rates.