Laparoscopic common bile duct exploration with primary closure: a single-center analysis of 743 consecutive patients

Laparoscopic common bile duct exploration (LCBDE) with primary closure remains limited in its adoption. We present the largest single-center series to date, evaluating outcomes and risk factors.

Consecutive patients undergoing LCBDE for choledocholithiasis (December 2020 to October 2025) were retrospectively analyzed. The primary outcome was overall morbidity; secondary outcomes included bile leak, residual stones, reoperation, and 30-day readmission. Logistic regression was used to identify risk factors.

Among 743 patients (median age, 61 years; 53.7% female). Procedural variants included transductal (choledochotomy, 50.7%), transcystic-junctional (4.8%), and triple-endoscopic (19.5%). Primary closure was achieved in 78.7%. Complete stone clearance was achieved in 95.6%. The median operative time and hospital stay were 90 min and 10 days, respectively. The conversion rate was 0.4%. Overall morbidity was 5.2%, with a bile leak rate of 0.40%, peritonitis rate of 1.35%, residual stones rate of 2.02%, readmission rate of 0.81%, and reoperation rate of 2.02%. No mortality occurred. In multivariable analysis, choledochotomy was independently protective against overall morbidity (odds ratio [OR], 0.44; P <.001), residual stones (OR, 0.43; P <.001), and reoperation (OR, 0.50; P =.006). The absence of preoperative endoscopic retrograde cholangiopancreatography was protective against residual stones (OR, 0.63; P =.046).

LCBDE with primary closure is safe and effective (bile leak, 0.40%; zero mortality). The 3 variants share the same principle: watertight, T-tube-free closure after definitive stone clearance. The transductal approach offers superior clearance and fewer complications; the transcystic-junctional variant is preferred for small-caliber bile ducts when it is anatomically feasible. Primary closure should be the default strategy when conditions permit.