Real-World Outcomes of Barbed Versus Interrupted Sutures for Laparoscopic Choledochotomy: A 12-Month Follow-Up in...

The optimal suture technique for primary closure after laparoscopic choledochotomy remains uncertain. We compared real-world outcomes of barbed continuous and conventional interrupted sutures in patients with choledocholithiasis.

This single-center retrospective cohort included 200 patients with choledocholithiasis who underwent laparoscopic common bile duct exploration with primary duct closure (January 2019 to December 2023). Patients received barbed continuous sutures (n=102) or interrupted sutures (n=98) according to surgeon preference in routine practice. The primary endpoint was biliary adverse events (bile leakage or biliary stricture) within 12 months. Multivariable logistic regression and supportive Cox models were used to explore associations after adjustment for recorded clinical covariates; intraoperative duct inflammation and wall-thickness grading were not prospectively standardized and therefore were unavailable for adjusted analyses.

Biliary adverse events occurred in 25.0% (50/200). The 12-month event rates were 19.6% (20/102) with barbed sutures and 30.6% (30/98) with interrupted sutures. Barbed sutures were associated with fewer adverse events (OR 0.74, 95% CI: 0.36-1.52; HR 0.61, 95% CI: 0.34-1.10). Independent predictors were age ≥70 years (HR 2.08), CBD diameter <8 mm (HR 2.56), maximum stone diameter ≥10 mm (HR 2.15), and surgeon experience ≤5 years (HR 2.51). Barbed sutures were associated with shorter suturing time, operative duration, postoperative stay, and drain duration (all P<0.001).

Barbed continuous sutures were associated with greater operative efficiency and faster recovery, whereas biliary adverse event rates did not differ significantly after adjustment. Given the nonrandomized retrospective design and unmeasured intraoperative confounding, these findings should be interpreted as exploratory.