Single-Incision Laparoscopic Common Bile Duct Exploration with a Single-Bend Internal Biliary Stent: A Consecutive Cohort Study of 112 Patients

Introduction: Single-incision laparoscopic common bile duct exploration (SIL-CBDE) with primary duct closure is technically demanding. This study evaluated a standardized SIL-CBDE protocol using a guidewire-pusher-single-bend internal biliary stent delivery system designed to permit spontaneous dislodgement. Materials and Methods: We retrospectively analyzed 112 consecutive patients who underwent SIL-CBDE with internal biliary drainage between April 2025 and April 2026. A guidewire-pusher-stent delivery system with a 5 Fr single-bend plastic stent was used for temporary transpapillary decompression. Technical proficiency was assessed using risk-adjusted cumulative sum (RA-CUSUM) analysis adjusted for age, body mass index, common bile duct (CBD) diameter, and stone characteristics. Results: Technical success was achieved in all patients. The mean operative time was 124.9 ± 19.9 minutes. The RA-CUSUM analysis identified an inflection point at case 55. Operative time decreased from 133.3 ± 21.7 minutes to 116.8 ± 13.7 minutes after this point ( P < .001). Prophylactic abdominal drainage was omitted in 58 patients (51.8%). Bile leakage occurred in 7 patients (6.2%) and was managed without reoperation. Spontaneous stent dislodgement was confirmed in 101 patients (90.2%). Retained CBD stones occurred in 4 patients (3.6%) and were successfully treated by endoscopic retrograde cholangiopancreatography-based endoscopic stone extraction. Conclusion: In selected patients, SIL-CBDE with a single-bend internal biliary stent appeared feasible and safe. This protocol may support temporary transpapillary decompression, spontaneous stent passage, and selective abdominal drain omission in enhanced recovery after surgery-oriented biliary surgery.