To evaluate clinical efficacy of laparoscopic cholecystectomy (LC) combined with laparoscopic transcystic bile duct exploration (LTCBDE) and primary suture in patients with cholecystolithiasis complicated with choledocholithiasis after failed endoscopic retrograde cholangiopancreatography (ERCP).

Clinical data of 158 patients with cholecystolithiasis and choledocholithiasis who experienced failed ERCP in Wuming Hospital of Guangxi Medical University from January 2020 to December 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 70 patients were male and 88 female, aged from 25 to 84 years, with a median age of 54 years. All patients were divided into two groups according to different surgical procedures. In the primary suture group, patients were treated with LC+LTCBDE+primary suture (n=62), and those in the T-tube drainage group received LC+LCBDE+T-tube drainage (n=96).

All patients were successfully treated by laparoscopic surgery with no conversion to open surgery or death. Intraoperative blood loss in the primary suture group was 21(18,23) ml, significantly less than 31(29,34) ml in the T-tube drainage group (Z=-9.557, P<0.001). In the primary suture group, the time to first flatus, duration of antibiotic use and the length of hospital stay were 2.0(1.0,2.0), 5.0(3.0,6.0) and 7.0(5.0,8.0)d, significantly shorter than 2.5(2.0,4.0),7.0(5.0,8.0) and 9.0(7.0,10.8)d in the T-tube drainage group (Z=-5.289,-6.182,-6.246; all P<0.001). In the primary suture group, the incidence rates of postoperative acute cholangitis, bile leakage and residual stones were 10%(6/62), 2%(1/62) and 6%(4/62), compared with 10%(10/96), 6%(6/96) and 15%(14/96) in the T-tube drainage group. No significant differences were noted between two groups (all P>0.05). The incidence of postoperative abdominal infection in the primary suture group was 8%(5/62), significantly lower than 22%(21/96) in the T-tube drainage group, and the difference was statistically significant (χ²=5.226, P=0.022). No acute pancreatitis or biliary stenosis occurred in two groups after surgery.

For patients with cholecystolithiasis complicated with multiple common bile duct stones after failed ERCP, if the choledochoscope can pass through the diameter of cystic duct, LC combined with LTCBDE and primary suture can effectively remove the stones, mitigate surgical trauma, reduce antibiotic use, shorten the length of postoperative hospital stay and promote rapid postoperative recovery, which is a safe, effective and feasible surgical procedure.