Common bile duct repair with titanium staples

Abstract

Background: Vascular Closure Staple (VCS) clips made of titanium were initially developed for microvascular anastomoses with little experience of their use in larger tubular structures. This study compares VCS clips and sutures in the closure of supraduodenal choledochotomy.

Methods: In nine pigs, two longitudinal incisions of the common bile duct (CBD) were randomly assigned to closure with 4-0 interrupted polyglactin sutures or VCS clips.

Results: Clip closure was significantly faster (116 ± 28 vs 581 ± 88 s). All nine CBDs were patent and without signs of calculus formation after 3 months. Clip closure resulted in slightly less narrowing of the duct lumen and thinner scar at the repair site. At histological examination, all 18 incisions had healed without signs of fistula formation or marked fibrosis.

Conclusions: Choledochotomy closure with VCS clips results in as good or better wound healing than suture closure, with a comparable degree of narrowing. The time required for clip closure is only about one-fifth that of suture closure.