Primary closure with self-disengaging biliary stent following laparoscopic CBD exploration in normal-diameter ducts: a propensity score matching study.

Laparoscopic Common Bile Duct Exploration (LCBDE) is highly effective for treating common bile duct stones (CBDS). This study aims to evaluate the safety and feasibility of primary closure with a self-disengaging biliary stent during LCBDE in patients with normal-diameter CBDs (≤ 8 mm) and to compare perioperative outcomes and complications with those in dilated CBDs (> 8 mm). From May 2022 to May 2024, patients with CBDSs who underwent LCBDE with primary closure and a self-disengaging biliary stent were retrospectively analyzed. Patients were stratified into two subgroups based on CBD diameter (normal: ≤8 mm vs. dilated: >8 mm). Propensity score matching (PSM) was adjusted for baseline differences between normal and dilated CBD groups, and perioperative indicators and postoperative complications were compared. Multivariate analysis identified risk factors for postoperative bile leakage. Of 491 patients, 343 underwent primary closure with a self-disengaging biliary stent during LCBDE. The mean operation time was 85 (IQR 70-110) min, with blood loss of 20 (IQR 15-20) ml. The postoperative hospital stay was 8 (IQR 8-10) days, and the hospitalization cost was CNY 28,143 (IQR 25,522-32,809). The overall complication rate was 32 (9.3%), with 25 (7.3%) experiencing bile leakage. The Charlson Comorbidity Index (CCI) score was an independent risk factor for bile leakage (OR 2.587; 95% CI 1.729-3.873, P < 0.001). PSM of dilated (> 8 mm, n = 225) and normal (≤ 8 mm, n = 118) CBD groups resulted in 114 matched pairs. No significant differences were observed in operative time, blood loss, hospital stay, costs, or complications between the groups. Primary closure with a self-disengaging biliary stent following LCBDE is equally safe and effective in patients with normal-diameter CBDs as in those with dilated ducts. CBD diameter should not be a contraindication for this technique. The CCI score is a critical predictor of bile leakage and should be considered in perioperative risk assessment.