Laparoscopic Common Bile Duct Exploration with Primary Closure: A Single-Center Analysis of 743 Consecutive Patients.

BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) with primary closure remains limited in adoption. We present the largest single-center series to date, evaluating outcomes and risk factors. METHODS: Consecutive patients undergoing LCBDE for choledocholithiasis (December 2020-October 2025) were retrospectively analyzed. The primary outcome was overall morbidity; secondary outcomes included bile leak, residual stones, reoperation, and 30-day readmission. Logistic regression identified risk factors. RESULTS: Among 743 patients (median age 61 years, 53.7% female). Procedural variants included transductal (choledochotomy, 50.7%), transcystic-junctional (4.8%), and triple-endoscopic (19.5%). Primary closure was achieved in 78.7%. Complete stone clearance was 95.6%. Median operative time and hospital stay were 90minutes and 10 days. Conversion rate was 0.4%. Overall morbidity was 5.2%, with bile leak 0.40%, peritonitis 1.35%, residual stones 2.02%, readmission 0.81%, and reoperation 2.02%. No mortality occurred. On multivariable analysis, choledochotomy was independently protective against overall morbidity (OR 0.44, p < 0.001), residual stones (OR 0.43, p < 0.001), and reoperation (OR 0.50, p = 0.006). Absence of preoperative endoscopic retrograde cholangiopancreatography (ERCP) was protective against residual stones (OR 0.63, p = 0.046). CONCLUSIONS: LCBDE with primary closure is safe and effective (bile leak 0.40%, zero mortality). The three variants share the same principle: watertight, T-tube-free closure after definitive stone clearance. The transductal approach offers superior clearance and fewer complications; the transcystic-junctional variant is preferred for small-caliber bile ducts when anatomically feasible. Primary closure should be the default strategy when conditions permit.