mary medical center ( affiliated to ucla of long beach , ca ) , who had laparoscopic cholecystectomy in another hospital by another surgeon .
ercp by gastroenterology was performed , but the surgeons were unable to insert a stent ( figure 1 ) . a clip noted across the common bile duct was leaking bile , and bile peritonitis developed . the patient was then taken to surgery . the surgical clip was removed , but extensive necrosis 4 cm in longitudinal and circumferencial length had developed .
the common duct was small , approximately 3 mm ; consequently , it proved difficult to do a roux - en - y enteric bypass .
previous experiences of anatomical dissection and research led me to believe that patching with round and falciform ligament would help the patient .   with proper retraction ,
it was sutured with proline 5 - 0 near the injury of the common bile duct , side - to - side to the round and falciform ligament circumferencial patching a 
10 french placed ( figure 2 ) and reinforced using 5 - 0 chromic interrupted sutures and tacked down with omentum ( figure 3 ) .
ercp unable to pass the stent because there is a clip across the common duct .
video laparoscopic anatomical photograph of the round and falciform ligament so close to the common bile duct it is able to overlap . with its own blood supply , it makes a perfect autologus graph .
graphic of the side - to - side anastomosis using proline 5 - 0 , running suture stented with a  t 
subsequently , the  t  tube was removed three months postoperatively , and ercp after five months showed a common duct without stenosis as presented in the x - ray films ( figure 4 ) .
in this particular patient , i did not have a better choice than to use a standard procedure , such as ercp stent , choledoco or hepatic jejunostomy or suturing the common duct with a 
the repair of the common duct injury using a round and falciform ligament after a clip necrosis was successful , and the patient was released without symptoms or stenosis of the common duct after 12 months of follow - up .
a definite evaluation of the procedure must await a longer period of follow - up and study .
 occasionally , as abdominal surgeons , we are confronted with common bile duct injury noted during video laparoscopic or open cholecystectomy . 
 usually this is solved by endoscopic retrograde cholangiopancreatography ( ercp ) sphincterotomy and stent , or enteric bypass , suture repair and tube drainage . however , after such procedures , there is a significant number of patients with postoperative stenosis.another alternative to repair common bile duct injury and correct postoperative stenosis is using the round and falciform ligament as circumferencial patch . due to their closeness to the common bile duct and their adequate blood supply , 
 they make a perfect autologus biological graft . 
CASE PRESENTATION
CONCLUSION