Primary closure with endoscopic nasobiliary drainage after laparoscopic common bile duct exploration: A safe and feasible strategy for nondilated common bile ducts

Purpose The preferred treatment for cholecystolithiasis combined with choledocholithiasis is laparoscopic cholecystectomy (LC)+laparoscopic common bile duct exploration (LCBDE)+primary closure (PC). However, the appropriateness of LC+LCBDE+PC in patients with nondilated common bile ducts (CBDs) remain unclear. This study aimed to investigate the feasibility and safety of LC+LCBDE+PC with intraoperative endoscopic nasobiliary drainage (IO-ENBD) for the treatment of choledocholithiasis with nondilated CBDs. Methods From May 2021 to January 2024, 257 consecutive patients with cholecystolithiasis combined with choledocholithiasis underwent LC+LCBDE in our institution were reviewed. The clinical and treatment outcomes of patients with nondilated CBDs (<8 mm) were retrospectively analyzed. Results Of these patients, 53 patients with nondilated CBDs successfully underwent LC+LCBDE+PC+IO-ENBD. The stone clearance rate was 100%, operation time was 142.66±29.20 minutes, intraoperative blood loss volume was 26.23±22.21 mL, postoperative hospital stay was 6.77±2.32 days. There was 1 case of postoperative bile leakage (1/53, 1.9%), which was resolved with conservative treatment. No reoperation or mortality occurred. During the median follow-up period of 24 months (range: 6–40 months), one patient (1/53, 1.9%) experienced stone recurrence 18 months after the operation. No residual stones or biliary stricture occurred. Conclusion LC+LCBDE+PC+IO-ENBD is a safe and effective single-stage strategy for the management of cholecystolithiasis combined with choledocholithiasis in patients with nondilated CBDs.