Clinical Decision-Making in Laparoscopic Common Bile Duct Exploration: Choosing Between Primary Closure and T-Tube...

Choledocholithiasis, or common bile duct (CBD) stones, is increasingly prevalent in aging populations worldwide. Laparoscopic common bile duct exploration (LCBDE) is a well-established minimally invasive procedure; however, the optimal method for choledochotomy closure-primary closure (PC) versus T-tube drainage (TTD)-remains controversial.

This narrative review summarizes the available evidence from randomized controlled trials, meta-analyses, and observational studies to compare perioperative practices, clinical outcomes, and patient-specific variables associated with PC and TTD following LCBDE.

Quantitative data from meta-analyses and recent clinical studies indicate that when complete stone clearance is achieved and patient conditions permit, PC is associated with significantly shorter operative time (by approximately 20 minutes), reduced hospital stay (by 1-2 days), and lower overall complication rates (e.g., 5.2% vs. 12.1% in selected series), without increasing the risks of bile leakage or biliary stricture. TTD remains valuable in scenarios involving residual stone risk, biliary tract inflammation, uncertain ductal anatomy, or limited institutional resources. Key determining factors include CBD diameter, infection status, choledochoscopic visualization quality, and operator expertise.

Both PC and TTD are valid therapeutic options following LCBDE, with PC preferred in uncomplicated cases and TTD indicated for high-risk scenarios. An individualized, patient-centered strategy based on intraoperative findings and institutional resources is essential to optimize clinical outcomes.