Single-center prospective study on triple-port laparoscopic cholecystectomy combined with choledochoscopic common bile duct exploration and primary closure without T-tube drainage for acute abdominal pain

Objective To evaluate the clinical efficacy of laparoscopic common bile duct exploration (LCBDE) combined with choledochoscopy and primary closure without T-tube drainage in managing acute abdominal pain caused by choledocholithiasis (common bile duct stones, CBDS) and cholecystolithiasis with acute cholecystitis. Methods A single-center prospective study was conducted at the Department of General Surgery, Beijing Fengtai Youanmen Hospital, from April 2024 to February 2025. Sixty-one patients with acute abdominal pain due to CBDS and cholecystolithiasis with acute cholecystitis were randomized into two groups: T-tube-free group (n = 35), Triple-port laparoscopic cholecystectomy (LC) + LCBDE with primary closure; T-tube group (n = 26), Four-port LC + LCBDE with T-tube drainage. Perioperative outcomes were compared between the groups. Results Baseline characteristics were comparable (all P  > 0.05). The T-tube-free group demonstrated superior outcomes in operative time, intraoperative blood loss, postoperative pain, duration of abdominal drainage, and hospital stay (all P  < 0.05). Each group had one case of biliary leakage, both resolved conservatively. No mortality, pancreatitis, conversion to open surgery, residual stones, biliary hemorrhage, or strictures occurred in either group. Conclusion Triple-port LC combined with LCBDE and primary closure without T-tube drainage is safe and feasible for acute abdominal pain. Compared to T-tube drainage, this approach better aligns with the principles of enhanced recovery after surgery (ERAS).