Comparison of laparoscopic manual suturing and laparoscopic stapler usage for gallbladder duodenal fistula stoma closure

Cholecystoduodenal fistula (CDF) is a rare complication of recurrent gallstone disease, characterized by chronic inflammation, localized ischemia, and tissue necrosis. In this study, the clinical outcomes associated with laparoscopic manual suturing and stapler-assisted closure were compared in the context of CDF repair with accompanying video presentations. Overall, 21 patients diagnosed with CDF who underwent treatment at Fujian Provincial Hospital between January 2010 and December 2024 were retrospectively analyzed. Participants were categorized into two groups: those who underwent stapler-assisted closure (stapler group, n = 12) and those who underwent manual suturing (manual suture group, n = 9). Intraoperative parameters, postoperative recovery markers, and complication rates were compared between groups. Statistical data were evaluated using SPSS version 26.0 (SPSS Inc., IL, USA) and p < 0.05 was considered as significant in all analyses. The patient characteristics and preoperative factors were similar in two groups (p > 0.05). The stapler group had a significantly shorter operative time in comparison with the manual suture group (72.5 min vs. 115.0 min, p < 0.001) and four patients (44.4%) in the manual suture group required conversion to open surgery (p:0.021). Subtotal cholecystectomy was performed in 5 patients (41.7%) in stapler group, and 3 patients (33.3%) in manual suture group. The sizes of the cholecystoduodenal fistulas were almost same between two groups (0.8 cm vs. 0.7 cm). Postoperative complications were mostly seen in manual suture group; 3 patients (33.3%) had duodenal fistula and 2 patients (22.2%) required reoperation. Postoperative recovery occurred more rapidly in the stapler group, with a shorter period to start to oral intake, for removal of nasogastric and drainage tubes; and a shorter duration of hospitalization time (p < 0.05). Laparoscopic stapler-assisted repair of CDF using the preserved gallbladder wall offers significant advantages over traditional manual suturing. It decreases the operative duration, lowers conversion rates, and reduces the odds of postoperative complications. Given these benefits, this technique is recommended for broader clinical adoption. However, in cases where the stapler use is inappropriate due to the technical issues; manual suturing can be the preferable method in selected cases.