Continuous Versus Interrupted Primary Closure after Laparoscopic Common Bile Duct Exploration for Choledocholithiasis: A Systematic Review and Meta-Analysis

Abstract

Background:

Primary closure after laparoscopic common bile duct exploration (LCBDE) has been increasingly adopted for choledocholithiasis. However, the optimal suturing technique remains unclear. We therefore performed a systematic review and meta-analysis comparing continuous and interrupted suturing (IS).

Methods:

A systematic search was conducted across PubMed, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials up to May 1, 2026. Pooled odds ratios and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed via the I² statistic.

Results:

Three observational studies, including 894 patients, were analyzed, of whom 419 underwent continuous suturing (CS), and 475 underwent IS. Compared with IS, CS was associated with significantly shorter operative time (MD −9.9 minutes; 95% CI −12.4 to −7.5; P < .01; I² = 3%). No significant differences were observed between techniques regarding intraperitoneal hemorrhage, biliary leakage, surgical site infection, biliary stricture, stone recurrence, hospital stay, or total hospitalization costs.

Conclusion:

Although the available evidence remains limited by the retrospective design and the exclusive inclusion of studies from Eastern centers, CS may represent a safe and efficient alternative to IS in selected patients undergoing LCBDE.