ThP3.4 - Suture Endoclips coding, a novel technique to improve efficiency and reduce errors In laparoscopic repair of peptic ulcer perforation

Abstract The presentation describes our a novel technique of using Endo clips to tag the sutures during laparoscopic repair of perforated peptic ulcer utilizing Graham omental patch, Methods Four patients presented with perforated peptic ulcer. All treated with Laparoscopically. Supine position with split leg was standard. 5 and10mm thirty-degree scopes were used to facilitate efficient and comprehensive washing, through 11 mm umbilical port and two 5 mm ports. An extra 5mm port was needed on the lateral right Upper Quadrant for drain or liver retractor. We used 5mm endoclips to tag the end of sutures and create a tunnel to pass the patch through it. Each suture end was tagged with either one, two or three clips, in order. The suture ends were held together to create a tunnel, where the omental patch was passed through that tunnel. Corresponding sutures end where identified easily by holding endoclips in order, then removed to allow the two ends to be tied without mixing the sutures. Furthermore, the endoclip tagging prevents suture looping around each other, minimizing wasted time, error and dislodging the stitches during identifying, correcting the looping and picking the corresponding ends. All patients had uneventful recovery, with assuring follow up. Conclusions Our novel technique of suture Coding with endolcips eliminated the confusion between the different suture threads and prevents looping and consequently improved the technique efficiency and prevent mistakes and loose ties