Is Primary Closure Safe for Patients With Nonsevere Acute Cholangitis? A Single-Center Study on Laparoscopic Common...

The safety and effectiveness of laparoscopic common bile duct exploration with primary closure in patients with nonsevere acute cholangitis remain debatable. The study aimed to evaluate the safety and effectiveness of laparoscopic common bile duct exploration with primary closure in patients with nonsevere acute cholangitis.

Patients with nonsevere cholangitis who underwent laparoscopic common bile duct exploration at our center between January 2014 and December 2024 were retrospectively reviewed. According to the manner of closure of the open common bile duct, patients were divided into Group A (primary closure) and Group B (T-tube insertion). Preoperative, intraoperative, and postoperative outcomes between the two groups were compared.

Altogether, 373 patients were included, with 269 patients in Group A and 104 patients in Group B. The baseline characteristics of Group A were not significantly different from those of Group B. Compared with Group B, Group A was associated with less estimated blood loss (P < 0.001), shorter operative time (P < 0.001), and a lower rate of blood transfusion (P < 0.001). Group A was also associated with shorter total hospital stay (P = 0.001), shorter postoperative hospital stay (P = 0.001), and lower rates of common bile duct stricture (P < 0.001) and residual stones (P < 0.001). One patient in Group A died within 30 d after surgery.

For patients with nonsevere acute cholangitis, primary closure is safe and effective, as it is associated with improved intraoperative outcomes and noninferior postoperative outcomes. However, these findings should be validated in prospective randomized controlled trials, given the biases related to patient selection and closure method.