title: Modified laparoscopic biliary enteric anastomosis procedure using handmade double-armed needles.
abstract: BACKGROUND
  Laparoscopic biliary enteric anastomosis (BEA) offers several advantages, including good visualization, which helps to overcome the compromised visual field resulting from the biliary tract being located on the right anterior side of the body at some distance from the surgical opening. Laparoscopic BEA, however, requires skillful manipulation of the forceps over a limited range to achieve optimal outcomes. Here we describe a modified and reorganized BEA technique that increases the simplicity and feasibility of the procedure.
  
  
  METHODS
  After biliary tract surgery for benign diseases such as laparoscopic choledocholithotomy, handmade double-sided needles were used for BEA in 20 patients. First, one of the needles was placed at the right edge of the bile duct wall from the outside to the inside, while the other arm of the needle entered the right edge of the intestine from the outside to the inside. Next, continuous sutures were placed on the posterior wall with the needle that was placed on the intestine. Then, continuous sutures were placed on the anterior wall with a second needle. Finally, both threads were laparoscopically tied.
  
  
  CONCLUSIONS
  This relatively simple and feasible method has demonstrated excellent results and will be beneficial in the clinical setting.
authors.affiliation: Nippon Medical School Hospital, Department of Surgery, Tokyo, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Mizuguchi
authors.affiliation: Nippon Medical School Hospital, Department of Surgery, Tokyo, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Nippon Medical School Hospital, Department of Surgery, Tokyo, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
mesh_terms: D000714:Anastomosis, Surgical; D001660:Biliary Tract Diseases / Q000601:surgery*; D004867:Equipment Design; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D009339:Needles; D013536:Suture Techniques
keywords: Biliary enteric anastomosis; double-sided needles; running suture