Laparoscopic choledocholithotomy for gallbladder and common bile duct stones: Outcomes of primary closure vs T-tube drainage

Abstract

BACKGROUND

Gallbladder stones combined with common bile duct stones are frequently encountered. Laparoscopic choledocholithotomy is an effective treatment, but the optimal bile duct closure method primary closure vs T-tube drainage remains controversial. Primary closure may offer faster recovery and fewer tube-related complications, yet its safety and advantages over T-tube drainage require further validation. This study compared the effectiveness and safety of the two methods.

AIM

To assess the comparative effectiveness and safety of primary ductal closure vs conventional T-tube drainage in patients undergoing laparoscopic choledocholithotomy for gallbladder and common bile duct stones.

METHODS

Clinical data of 102 patients who underwent surgery in the First Department of General Surgery, Peking University Shougang Hospital, from October 2023 to October 2025, were retrospectively analyzed. The primary closure group consisted of 52 patients, and the T-tube drainage group had 50 patients. Factors for comparison were stone number and size, common bile duct diameter, stone clearance rate, liver function variables, operation time, drainage volume, indwelling time, postoperative hospital stay duration, total costs, and postoperative complications. Multivariate logistic regression was used to adjust for baseline differences in common bile duct diameter.

RESULTS

The two groups did not differ significantly in stone characteristics or clearance rates (P > 0.05), although common bile duct diameter distribution differed between groups (P < 0.05). After adjusting for common bile duct diameter and other covariates, primary closure remained associated with significantly shorter operative time, less drainage from the Winslow foramen, faster tube removal, shorter hospital stay, and lower costs (all P < 0.05). Postoperative day 3 liver function parameters (total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase) were significantly lower in the primary closure group, but these differences should be interpreted with caution due to potential confounding by intraoperative factors. While bile leakage did not differ significantly between the two methods, the primary closure group suffered from significantly fewer electrolyte imbalances (P < 0.05); the majority of electrolyte disturbances in the T-tube group were hypokalemia and hyponatremia, possibly related to biliary fluid loss.

CONCLUSION

Primary closure appears to be a safe and effective alternative to T-tube drainage during laparoscopic choledocholithotomy, with potential benefits in recovery and resource utilization. However, these findings are limited by the retrospective, single-center design and residual confounding; prospective studies are needed.

Keywords: Cholecystolithiasis; Choledocholithiasis; Laparoscopic choledocholithotomy; Primary closure; T-tube drainage

Core Tip: Laparoscopic common bile duct exploration (LCBDE) is a standard treatment for cholecystocholedocholithiasis. This retrospective cohort study compares primary closure (PC) vs T-tube drainage (TD) after LCBDE. The findings indicate that PC is a safe and feasible alternative. Compared to TD, PC is associated with faster operative times, reduced abdominal drainage, shorter hospital stays, lower medical costs, and a significantly decreased incidence of postoperative electrolyte disturbances, without increasing the risk of bile leakage or other major complications.