The length of the suture material used in various surgical procedures is very important. For the ease of intracorporeal suturing it is advised to use a suture length of about 6 inches. In surgical situations such as intestinal anastomosis, gastrojejunostomy, billio enteric bypass (choledocho
duodenostomy; choledochojejunostomy) or while reperitonalising a large area in TAPP, a 6 inches suture length is insufficient. A larger suture would be difficult to manage and would add to an already difficult / advanced laparoscopic procedure.

To overcome this situation we have applied an innovation in these circumstances. The original concept is of Dr A K Hemal from AIIMS which we have adapted to our surgical procedures.

Two suture lengts of 6 inches with desired needles is taken. It is an additional benefit if the suture material is of different colour e.g. dyed purple vicryl and non-dyed white vicryl. This would help in easier identification and orientation at laparoscopy. Two free ends of the suture are tied together and the knot so formed acts as a buttress.

In choledochoduodenostomy the anastomosis is started at 6 o’clock position and one half of the suture anastomoses the one half of duodenum and CBD to travel to reach 12 o’clock. Similarly other half sutures the rest and the two sutures meet at 12 o’clock were they are tied together to complete the anastomosis. The advantages accrued are:
1. Suture handling is technically easier;
2. Two corners of anastomosis are well secured.