Improved outcomes and prognostic risk prediction for laparoscopic common bile duct exploration with primary closure...

To compare laparoscopic common bile duct exploration (LCBDE) with primary closure plus double-J stent versus T-tube drainage after LCBDE, and to identify risk factors for poor outcome.

In this retrospective cohort study, a propensity score matching approach (1:1) was applied to eligible patients, dividing them into an observation group (n = 59, LC+LCBDE with primary closure and double-J biliary stent) and a control group (n = 59, LC+LCBDE with T-tube drainage), yielding a total sample size of 118 cases. Perioperative outcomes, liver function, inflammatory markers, postoperative complications, and stone recurrence were compared between the two groups. Univariate and multivariable logistic regression analyses were performed to identify prognostic risk factors.

The observation group showed a significantly higher overall clinical efficacy rate than the control group (94.92% vs. 81.36%, P = 0.030) and a lower overall complication rate (10.17% vs. 25.42%, P = 0.030). The observation group also showed shorter operative time, reduced intraoperative blood loss, shorter hospital stay, and lower total hospitalization costs (all P < 0.001). Multivariate analysis identified age ≥ 60 years, BMI ≥ 24 kg/m², common bile duct wall thickness ≥ 6 mm, and sphincter of Oddi dysfunction as independent predictors of adverse postoperative outcome (all P < 0.05).

LC+LCBDE with primary closure and double-J biliary stent placement is superior to T-tube drainage, offering greater efficacy, accelerated recovery, and fewer complications. Independent risk factors for adverse postoperative outcomes include advanced age, higher BMI, increased common bile duct wall thickness, and sphincter of Oddi dysfunction.