Primary suture of the common bile duct, also called immediate choledochorrhaphy, consists of making a perfect suture of the surgical incision of the duct after having completely removed the intracholedochal concretions and after having verified the patency of the papilla of Vater.
A normal elimination of bile through the papilla of Vater with complete absence of stagnation for the first two weeks after operation is the most important requisite for healing of the incision by first intention (Walzel1), but this depends on patency of the papilla of Vater and on free elimination of bile after removal of the concretions. According to modern criteria, the thickness of the wall of the duct, the dilatation of the ductal lumen, the turbid aspect of the bile and the presence of gravel in the choledochal bile, as well as other minor alterations, are factors of secondary importance (Weglowski2) in healing of the
MIRIZZI PL. PRIMARY SUTURE OF THE COMMON BILE DUCT IN CHOLEDOCHOLITHIASIS. Arch Surg. 1942;44(1):44-54. doi:10.1001/archsurg.1942.01210190047006