PRIMARY CLOSURE VERSUS T-TUBE DRAINAGE AFTER LAPAROSCOPIC COMMON BILE DUCT EXPLORATION: AN UPDATED SYSTEMATIC REVIEW OF SAFETY AND PERIOPERATIVE OUTCOMES

Abstract

This study aimed to compare the safety and perioperative outcomes of primary common bile duct closure and T-tube drainage after laparoscopic bile duct exploration in patients with choledocholithiasis. An updated systematic review was conducted according to PRISMA 2020, including clinical trials and comparative studies evaluating primary closure and T-tube drainage. Evidence synthesized through June 2024 comprised 31 studies and 4,432 patients and was complemented by subsequently published evidence. Primary closure was consistently associated with shorter operative time and hospital stay, without a demonstrated increase in bile leakage, biliary stricture, or recurrent stones. Recent studies also reported favorable results in elderly patients and selected individuals with nonsevere acute cholangitis. However, the predominance of observational studies and the potential for confounding by indication require cautious interpretation. Primary closure therefore represents a safe alternative to routine T-tube drainage when complete duct clearance, adequate distal patency, and favorable anatomic conditions for suturing are present.