Primary choledochorraphy after laparoscopic common bile duct exploration: comparative study of 3 different methods, safety, and efficacy

Erlinda Daniela Padilla Zegarra; Robert Memba Ikuga; Daniel Coronado Llanos; Esther Nve Obiang; Natalia Bejarano González; Erik LLàcer-Millán; Laia Estalella Mercadé; Elena Ramirez Maldonado; Mihai-Calin Pavel; Maria Alejandra Guerrero Ortiz; Rosa Jorba Martin

doi:10.1016/j.gassur.2025.102122

Primary choledochorraphy after laparoscopic common bile duct exploration: comparative study of 3 different methods, safety, and efficacy

J Gastrointest Surg. 2025 Jun 19;29(9):102122. doi: 10.1016/j.gassur.2025.102122. Online ahead of print.

Affiliations

¹ Department of Surgery, Joan XXIII University Hospital of Tarragona, Tarragona, Catalonia, Spain. Electronic address: erlindadpz@gmail.com.
² Department of Surgery, Joan XXIII University Hospital of Tarragona, Tarragona, Catalonia, Spain.
³ Department of Surgery, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain.
⁴ Department of Surgery, General Hospital of Granollers, Granollers, Barcelona, Spain.
⁵ Department of Surgery, Parc Taulí University Hospital, Sabadell, Barcelona, Spain.

PMID: 40543598
DOI: 10.1016/j.gassur.2025.102122

Abstract

Background: Primary closure of the common bile duct (CBD) after laparoscopic exploration is a crucial aspect of biliary surgery. Evidence suggests that single-stage laparoscopic CBD exploration (LCBDE) is more efficient and cost-effective than a 2-stage strategy involving endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. This study compares different suture materials used for primary CBD closure to assess their safety and efficacy.

Methods: This retrospective multicenter cohort study analyzed data from 4 hospitals between September 2010 and September 2022. Patients who underwent LCBDE with primary closure were included. The objective was to compare outcomes based on suture materials and sizes used for choledochorrhaphy after LCBDE. The outcomes measured included biliary leakage rates (primary endpoint), complication rates, and recovery times.

Results: A total of 178 patients were analyzed. Bile leaks were less frequent with 5-0 monofilament and 4-0 barbed sutures (1 and 7 cases) compared with 4-0 monofilament (12 cases), although not statistically significant (P =.098). No differences were observed in operative time, hospital stay, or readmission. Conversion to open surgery occurred in 17 patients and was significantly associated with 4-0 monofilament (P =.003) but unrelated to suture type. Although 4-0 monofilament showed a higher bile leak rate (7.1%) than 5-0 monofilament (2.8%) and 4-0 barbed (0.6%), a larger sample is needed to confirm statistical significance.

Conclusion: The type of suture material used for laparoscopic CBD closure did not significantly influence complication rates. Although 5-0 monofilament and 4-0 barbed sutures have a lower tendency for bile leaks and shorter hospital stays, further randomized prospective studies with larger samples are needed to confirm these findings.

Keywords: Biliary leakage; Choledocholithiasis; Laparoscopic common bile duct stone; Primary closure; Suture.