ORIGINAL RESEARCH article
Front. Surg.
Sec. Visceral Surgery
This article is part of the Research TopicPerioperative Management and Clinical Challenges in Elderly Major Surgical PatientsView all 8 articles
Efficacy and safety of primary suture following laparoscopic common bile duct exploration in the treatment of elderly patients with cholecystolithiasis complicated by choledocholithiasis
Provisionally accepted
- 1Department of General Surgery, Aerospace Center Hospital, Beijing, China
- 21st Medical Center of Chinese PLA General Hospital, Beijing, China
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Background and Aim: To evaluate the efficacy and safety of primary suture following laparoscopic common bile duct exploration in the treatment of elderly patients with cholecystolithiasis complicated by choledocholithiasis. Methods: We retrospectively reviewed 164 elderly patients whose age over 70 years and who underwent laparoscopic cholecystectomy plus laparoscopic common bile duct exploration at our center from January 2015 to December 2024. Patients were categorized into two groups that including the primary suture following LC+LCBDE group (PS group) and the T-tube drainage following LC+LCBDE group (T-tube group) according to the surgical strategy. General data, intraoperative and postoperative outcomes, and postoperative complications in the two groups were compared and analyzed. Results: There were no significant differences in age (77.1±4.6 vs. 78.3±5.2 years, p=0.126), gender (p=0.523), BMI (24.7±2.1 vs. 24.3±1.8, p=0.192), diameter of CBD (14.1±3.8 vs. 13.4±2.5 mm, p=0.158), ASA risk grading (p=0.545), hematological indicators and comorbidities (p>0.05) between the two groups. All patients of the two groups successfully underwent laparoscopic surgery without any case converted to laparotomy. There was no significant difference in intraoperative blood loss between the PS group and T-tube group (54.6±26.4 vs. 58.8±24.7 ml, p=0.297). However, surgical duration (113.7±23.8 vs. 129.2±39.5 min, p=0.004) was significantly shorter in the PS group. In addition, the PS group had significantly shorter exhaust times (2.1±0.7 vs. 2.9±0.6 days, p=0.000), postoperative hospital stay (6.1±1.9 vs. 8.2±1.6 days, p=0.000) and lower hospitalization expenses (21.2±5.9 vs. 26.6±7.4 thousands, p=0.000). In terms of postoperative complications, there were significant differences in incidence of the electrolyte disturbances (11.3% vs. 23.7%, p=0.042) and bile leakage (0.0% vs. 8.6%, p=0.030) between the PS group and T-tube group. No serious complications such as intra-abdominal infection, bleeding, or death occurred in both two groups. Conclusion: Primary suture following LCBDE is a safe and effective treatment approach for cholecystolithiasis combined with choledocholithiasis in elderly patients. Strictly executing the surgical criteria, primary suture offers superior perioperative outcomes over T-tube drainage, facilitating patients' recovery without increasing postoperative complications.
Keywords: Choledocholithiasis, Laparoscopic common bile duct exploration, Primary suture, T-tube drainage, elderly patients
Received: 11 Aug 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Li, Xuhong and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhenyu Wu, wzysurg@sina.com
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