Prospective randomized trial of triple port laparoscopic cholecystectomy combined with choledochoscopic common bile duct exploration and primary closure for acute abdominal pain

Abstract

Abstract 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. 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. 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. 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).