Clinical application of a self- dislodging biliary stent for one-stage suturing following choledochotomy

Choledochal exploration remains a reliable and effective therapeutic strategy for the management of choledocholithiasis. Nevertheless, the optimal approach to bile duct closure following exploration-specifically the choice between T-tube drainage and primary suture closure-remains controversial, with no clear consensus established in current surgical practice.

This study aims to evaluate the safety and efficacy of self-detachable biliary stents in achieving primary closure following choledochotomy.Secondary research objective: Potential complications associated with the innovative surgical approach of using a self-dislodging biliary stent.

From January 2021 to May 2023, a total of 112 patients diagnosed with choledocholithiasis were enrolled in this study. Among them, 60 patients were assigned to the TTD group, in which laparoscopic choledochotomy with T-tube drainage was performed, while 52 patients were included in the PDC group, receiving primary duct closure combined with placement of a self-detachable biliary stent. Postoperative outcomes were compared between the two groups, including operative time, time to first defecation, length of hospital stay, perioperative changes in hematological and liver function parameters, as well as the incidence of complications such as intra-abdominal hemorrhage, bile leakage, electrolyte disturbances, and wound infection.

There were no significant differences between the two groups with respect to operative time and intraoperative blood loss (P > 0.05). However, the time to first defecation and length of hospital stay were significantly shorter in the PDC group compared with the TTD group (P < 0.05). Postoperative WBC, TB, DB, and ALB levels did not differ significantly between the two groups (P > 0.05), whereas postoperative ALT, AST, and TBA levels were significantly different (P < 0.05). In addition, the overall incidence of postoperative complications was significantly lower in the PDC group than in the TTD group (P < 0.05).

Laparoscopic choledochal exploration followed by primary closure with a self-detachable biliary stent appears to be a safe, effective, and economically favorable strategy for the management of choledocholithiasis. This technique has the potential to serve as an alternative to conventional T-tube drainage, offering comparable safety while reducing postoperative complications and healthcare costs.