COMMON BILE-DUCT REPAIR WITH TITANIUM STAPLES - COMPARISON WITH SUTURE CLOSURE

Background: Vascular Closure Staple (VCS) clips made of titanium were initially developed for microvascular anastomoses with little experien ce of their use in larger tubular structures. This study compares VCS clips and sutures in the closure of supraduodenal choledochotomy. Meth ods: In nine pigs, two longitudinal incisions of the common bile duct (CBD) were randomly assigned to closure with 4-0 interrupted polyglact in sutures or VCS clips. Results: Clip closure was significantly faste r (116 +/- 28 vs 581 +/- 88 s). All nine CBDs were patent and without signs of calculus formation after 3 months. Clip closure resulted in s lightly less narrowing of the duct lumen and thinner scar at the repai r site. At histological examination, all 18 incisions had healed witho ut signs of fistula formation or marked fibrosis. Conclusions: Choledo chotomy closure with VCS clips re suits in as good or better wound hea ling than suture closure, with a comparable degree of narrowing. The t ime required for clip closure is only about one-fifth that of suture c losure.