title: Effectiveness of a barbed suture in the repair of bile duct injury during laparoscopic cholecystectomy: Report of two cases.
abstract: BACKGROUND
  Bile duct injury during laparoscopic cholecystectomy occurs in rare cases. We report two cases using barbed suture for repair in bile duct injury during laparoscopic cholecystectomies.
  
  
  METHODS
  The first patient was a 73-year-old woman who underwent elective laparoscopic cholecystectomy for cholecystolithiasis. When the gallbladder was dissected from the bed, bile spillage was observed and an injured small bile duct was detected. The bile duct could not be managed using a titanium clip. The second patient was an 83-year-old woman who underwent emergent laparoscopic cholecystectomy for gallbladder torsion. After the gallbladder was dissected from the bed, bile spillage was observed. In both cases, a running suture, of absorbable monofilament 3-0 barbed suture, was used to laparoscopically repair the injuries.
  
  
  CONCLUSIONS
  Laparoscopic repair of a bile duct injury is technically challenging, especially in the gallbladder bed where suturing is very difficult because of the tangential approach and the risk of additional liver laceration. Barbed sutures have the benefit of being knotless, thus, performing a running suture is not difficult, even in laparoscopic procedures. Further, absorbable and monofilament threads are generally better suited for biliary surgery, compared with non-absorbable and braided sutures, because of the potential association of the other types of materials with bile duct stone and stricture formation.
  
  
  CONCLUSIONS
  We believe that the V-Loc™ device is an effective and appropriate option for bile duct injuries that occur during laparoscopic cholecystectomies, particularly around the gallbladder bed, and it is especially useful for surgeons unfamiliar with intracorporeal knot tying.
authors: Department of Digestive Surgery, Niigata City Hospital, Niigata, 950-1197, Japan. Electronic address: niigata.takahashi@hosp.niigata.niigata.jp.
authors: Yusuke
authors: Y
authors: Takahashi
authors: Department of Digestive Surgery, Niigata City Hospital, Niigata, 950-1197, Japan.
authors: Naoyuki
authors: N
authors: Yokoyama
authors: Department of Digestive Surgery, Niigata City Hospital, Niigata, 950-1197, Japan.
authors: Natsumi
authors: N
authors: Matsuzawa
authors: Department of Digestive Surgery, Niigata City Hospital, Niigata, 950-1197, Japan.
authors: Daisuke
authors: D
authors: Sato
authors: Department of Digestive Surgery, Niigata City Hospital, Niigata, 950-1197, Japan.
authors: Tetsuya
authors: T
authors: Otani
keywords: Barbed suture; Bile duct injury; Cholecystectomy