TITLE:
Primary Duct Closure versus T-Tube Drainage after Laparoscopic Common Bile Duct Exploration in Older Patients: A Propensity Score-Matched Study
AUTHORS:
Heqian Huang, Liang Xu, Zhe Fu, Xiao Huang, Jianchu Wang
KEYWORDS:
Older Patients, Choledocholithiasis, Laparoscopic Common Bile Duct Exploration, Primary Duct Closure, T-Tube Drainage, Propensity Score Matching
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.9,
September
16,
2026
ABSTRACT: Objective: This paper aims to compare the safety and clinical effectiveness of primary duct closure and T-tube drainage after laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration (LC + LCBDE) in older patients with common bile duct stones. Methods: We reviewed records from one center. The cohort included 202 patients aged 65 years or older who underwent LC + LCBDE. Eighty-one received primary closure, and 121 received T-tube drainage. We matched patients 1:1 without replacement. The model used 13 preoperative variables and a propensity-score caliper of 0.1. We checked balance with standardized mean differences (SMDs). We analyzed 73 matched pairs with paired Wilcoxon signed-rank or exact McNemar tests. We report paired effects with 95% confidence intervals (CIs). Results: PSM produced 73 matched pairs. The largest absolute SMD fell from 0.364 before matching to 0.134 after matching. The primary-closure group had a shorter hospital stay [8.00 (6.00, 11.00) vs 12.00 (9.00, 15.00) days; paired median difference, −3.0 days; 95% CI, −5.0 to −2.0; P Conclusion: In this matched cohort of older patients, primary closure was linked to faster recovery. The clearest difference was a shorter hospital stay. Stone outcomes and major complications were similar. Residual confounding remains possible, and the database lacked details on individual complication types. These findings cannot prove cause and effect. Primary closure remains an option when the surgeon can close the duct securely.