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Background <p>Laparoscopic common bile duct exploration (LCBDE) is an important surgical treatment for choledocholithiasis; however, the choice between indwelling T-tube placement and primary suture remains controversial. This study aimed to evaluate the safety and feasibility of LCBDE coupled with primary suture using a prospective cohort design, as well as to summarize the key techniques of primary suturing.</p> Methods <p>Patients with choledocholithiasis who met the inclusion criteria between January 2019 and March 2023 were enrolled. The primary suture group comprised patients who underwent LCBDE with primary closure, while the T-tube drainage group consisted of those who received LCBDE with T-tube drainage. Perioperative data and follow-up outcomes were collected and statistically analyzed for both groups.</p> Results <p>Operative time (120.00 [100.00–139.50] vs. 99.00 [85.00–118.50] min; <i>P</i> = 0.000) and postoperative hospital stay (7.00 [5.00–9.00] vs. 5.00 [4.00–6.00] days; <i>P</i> = 0.000) differed significantly between groups. No significant differences were observed in estimated blood loss (40.7 ± 24.1 vs. 41.4 ± 23.7&#xa0;mL; <i>P</i> = 0.537), conversion rate to laparotomy (2.38% vs. 2.27%; <i>P</i> = 0.918), time to gastrointestinal function recovery (2.1 ± 0.7 vs. 2.0 ± 0.6&#xa0;days; <i>P</i> = 0.317), or postoperative complication rate (2.92% vs. 3.18%; <i>P</i> = 0.959). During follow-up, one case of common bile duct (CBD) stenosis and one case of extrahepatic cholangiocarcinoma occurred in the T-tube group; no such complications were observed in the primary suture group. The rates of residual stones (1.75% vs. 0.45%; <i>P</i> = 0.225) and recurrent stones (1.75% vs. 1.81%; <i>P</i> = 0.980) were without statistical significance.</p> Conclusion <p>In our grouping situation, LCBDE and primary suture is safer and more feasible than T-tube drainage in operative time and postoperative hospital stay. This conclusion has certain reference value for clinicians to choose the surgical method in laparoscopic surgery for choledocholithiasis.</p>

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Laparoscopic primary suture versus T-tube drainage for choledocholithiasis: a comparative analysis of efficacy and safety

  • 期刊论文

  • 发表日期：

    2025年12月22日

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  • Hongrui Zeng,
  • Jingjing Li,
  • Yan Liu,
  • Zhujun Yi,
  • Dingzhi Liu,
  • Lang Yan,
  • Lei Liu,
  • Lunjian Xiang

摘要

Background

Laparoscopic common bile duct exploration (LCBDE) is an important surgical treatment for choledocholithiasis; however, the choice between indwelling T-tube placement and primary suture remains controversial. This study aimed to evaluate the safety and feasibility of LCBDE coupled with primary suture using a prospective cohort design, as well as to summarize the key techniques of primary suturing.

Methods

Patients with choledocholithiasis who met the inclusion criteria between January 2019 and March 2023 were enrolled. The primary suture group comprised patients who underwent LCBDE with primary closure, while the T-tube drainage group consisted of those who received LCBDE with T-tube drainage. Perioperative data and follow-up outcomes were collected and statistically analyzed for both groups.

Results

Operative time (120.00 [100.00–139.50] vs. 99.00 [85.00–118.50] min; P = 0.000) and postoperative hospital stay (7.00 [5.00–9.00] vs. 5.00 [4.00–6.00] days; P = 0.000) differed significantly between groups. No significant differences were observed in estimated blood loss (40.7 ± 24.1 vs. 41.4 ± 23.7 mL; P = 0.537), conversion rate to laparotomy (2.38% vs. 2.27%; P = 0.918), time to gastrointestinal function recovery (2.1 ± 0.7 vs. 2.0 ± 0.6 days; P = 0.317), or postoperative complication rate (2.92% vs. 3.18%; P = 0.959). During follow-up, one case of common bile duct (CBD) stenosis and one case of extrahepatic cholangiocarcinoma occurred in the T-tube group; no such complications were observed in the primary suture group. The rates of residual stones (1.75% vs. 0.45%; P = 0.225) and recurrent stones (1.75% vs. 1.81%; P = 0.980) were without statistical significance.

Conclusion

In our grouping situation, LCBDE and primary suture is safer and more feasible than T-tube drainage in operative time and postoperative hospital stay. This conclusion has certain reference value for clinicians to choose the surgical method in laparoscopic surgery for choledocholithiasis.