title: Knotless choledochorraphy with barbed suture, safe and feasible.
abstract: To describe the safety and feasibility of a running continuous unidirectional barbed suture (V-Loc, Covidien, Mansfield, MA) for primary common bile duct closure while performing laparoscopic common bile duct exploration (LCBDE).
  
  
  
  LCBDE is nowadays the best approach for treating complex common bile duct lithiasis or cases where the endoscopic retrograde cholangiopancreatography has failed. It is clear that the primary closure of the common bile duct must be preferred over the T-tube drainage. The actual technical aspects offer room for improvement. We present our experience with barbed suture, for which recently, various fields of surgery have become interested in and which now has a series of studies that support it for several uses.
  
  
  
  Between July 2012 and July 2014, 54 consecutive patients with bile duct stones underwent LCBDE by a single surgeon. Perioperative outcomes and 30-day complications were recorded.
  
  
  
  Upon the completion of the exploration, 50 patients had primary common bile duct closure using knotless unidirectional barbed 3-0 V-Loc 90 suture, and 4 patients were excluded. All of the sutures were performed without knot tying. The procedure in all patients was successfully performed with no intraoperative complications. There were no bile leaks in the 50 patients or other postoperative complications such as infection, need for reintervention or death.
  
  
  
  The use of unidirectional knotless barbed suture (V-Loc 90) is safe, feasible and effective on LCBDE for primary common bile duct closure. The biliary leak rate is acceptably low and comparable to the rate reported in the literature. This report is our initial experience that needs further clinical trials.
authors.affiliation: Hospital General Zona Norte, Puebla, Mexico. drluisfedz@hotmail.com.|Centro Integral de Enfermedades Digestivas, 2 Oriente 415, Col Centro, CP: 72760, San Pedro Cholula, Puebla, Mexico. drluisfedz@hotmail.com.
authors.forename: Luis C
authors.identifier: 0000-0002-9229-7512
authors.initials: LC
authors.lastname: Fernandez
authors.affiliation: Hospital General Zona Norte, Puebla, Mexico.|Hospital General ISSSTE, Puebla, Mexico.
authors.forename: Augusto
authors.initials: A
authors.lastname: Toriz
authors.affiliation: Hospital General Zona Norte, Puebla, Mexico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Hernandez
authors.affiliation: Hospital General Zona Norte, Puebla, Mexico.
authors.forename: Norberto
authors.initials: N
authors.lastname: Sanchez
authors.affiliation: Hospital General Zona Norte, Puebla, Mexico.
authors.forename: Erick
authors.initials: E
authors.lastname: Linares
authors.affiliation: Hospital General Zona Norte, Puebla, Mexico.
authors.forename: Massiel
authors.initials: M
authors.lastname: Zenteno
authors.affiliation: Hospital General "Dr. Manuel Gea Gonzalez", Mexico City, Mexico.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Cuendis
authors.affiliation: Hospital General ISSSTE, Mexicali, Mexico.
authors.forename: Jose
authors.initials: J
authors.lastname: Olivares
authors.affiliation: Hospital General ISSSTE, Puebla, Mexico.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Guerrero
authors.affiliation: Hospital General ISSSTE, Puebla, Mexico.|Centro Integral de Enfermedades Digestivas, 2 Oriente 415, Col Centro, CP: 72760, San Pedro Cholula, Puebla, Mexico.
authors.forename: Cesar F
authors.initials: CF
authors.lastname: Cervantes
mesh_terms: D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D003135:Common Bile Duct / Q000601:surgery*; D004322:Drainage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D013536:Suture Techniques
keywords: Barbed suture; Bile ducts; Choledochal closure; Choledochoraphy; Knotless suture; V-Loc