Single-stage laparoscopic management for concomitant gallstones and common bile duct stones versus two stages using endoscopic retrograde cholangiopancreatography procedures
DOI:
https://doi.org/10.18203/2349-2902.isj20250554Keywords:
Common bile duct stones, Laparoscopic common bile duct exploration, Laparoscopic cholecystectomy, Endoscopic retrograde cholangiopancreatographyAbstract
Background: The optimal treatment for common bile duct (CBD) stones remains debated, with options including open or laparoscopic exploration, and endoscopic retrograde cholangiopancreatography (ERCP) before, during, or after laparoscopic cholecystectomy (LC). This study compared outcomes of one-stage (LECBD+LC) and two-stage (ERCP+LC) procedures for patients with gallstones and CBD stones, focusing on complications and patient satisfaction.
Methods: A randomized retrospective and prospective study included 200 patients with gallstones and CBD stones. Patients were divided into group I (n=100), undergoing one-stage laparoscopic CBD exploration (transcystic or transcholedochal) plus LC, and group II (n=100), undergoing two-stage preoperative ERCP then LC. Outcomes included operative time, complications, hospital stay, residual stones, and patient satisfaction.
Results: Mean age was 43.16±12.66 in group I and 41.52±9.44 in Group II, with no significant gender differences. Preoperative jaundice was present in 88 group I and 86 group II patients. Operative times, conversion rates, and complication rates were similar. The visual analogue scale (VAS) score at 24 hours was lower in group I but comparable at 3 days. Hospital stays were similar, with 3% residual stones in group I and 0% in group II. Patient satisfaction and mortality rates showed no significant differences.
Conclusions: One-stage LCBDE with LC is equivalent to two-stage ERCP plus LC in terms of operative time, complications, hospital stay, residual stones, and patient satisfaction. Both approaches are effective, with no significant differences in outcomes.
Metrics
References
Podda M, Polignano FM, Luhmann A, Wilson MSJ, Kulli C, Tait IS. Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis. Surg Endosc. 2016;30(3):845-61. DOI: https://doi.org/10.1007/s00464-015-4303-x
Singh AN, Kilambi R. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis. Surg Endosc. 2018;3(9):3763-76. DOI: https://doi.org/10.1007/s00464-018-6170-8
Mattila A, Mrena J, Kellokumpu I. Cost-analysis and effectiveness of one-stage laparoscopic versus two-stage endolaparoscopic management of cholecystocholedocholithiasis: a retrospective cohort study. BMC surgery. 2017;17(1):79-88. DOI: https://doi.org/10.1186/s12893-017-0274-2
Pulappadi VP, Srivastava DN, Madhusudhan KS. Diagnosis and management of hemorrhagic complications of percutaneous transhepatic biliary drainage: a primer for residents. Br J Radiol. 2021;94(1120): 20200879. DOI: https://doi.org/10.1259/bjr.20200879
Lu J, Cheng Y, Xiong X-Z, Lin Y-X, Wu S-J, Cheng N-S. Two-stage vs single-stage management for concomitant gallstones and common bile duct stones. World J Gastroenterol. 2012;18(24):3156-66. DOI: https://doi.org/10.3748/wjg.v18.i24.3156
Li Z-Q, Sun J-X, Li B, Dai X-Q, Yu A-X, Li Z-F. Meta-analysis of single-stage versus two-staged management for concomitant gallstones and common bile duct stones. J Minim Access Surg. 2020;16(3):206-15. DOI: https://doi.org/10.4103/jmas.JMAS_146_18
Gaied II, Ali MM, Shehata AM, Hassan AM. Concomitant ERCP and laparoscopic cholecystectomy for management of gallstones complicated by obstructive jaundice versus two sessions procedure comparative study, Minia university hospital experience. Minia J Med Res. 2023;34(1):133-42. DOI: https://doi.org/10.21608/mjmr.2023.182178.1250
Lin Y, Su Y, Yan J, Li X. Laparoendoscopic rendezvous versus ERCP followed by laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis: a systemic review and meta-analysis. Surg Endosc. 2020;34(9):4214-24. DOI: https://doi.org/10.1007/s00464-020-07698-y
Allen NL, Leeth RR, Finan KR, Tishler DS, Vickers SM, Wilcox CM, et al. Outcomes of cholecystectomy after endoscopic sphincterotomy for choledocholithiasis. J Gastrointest Surg. 2006;10(2):292-6. DOI: https://doi.org/10.1016/j.gassur.2005.05.013
Donkervoort S, Van Ruler O, Dijksman L, van Geloven A, Pierik E. Identification of risk factors for an unfavorable laparoscopic cholecystectomy course after endoscopic retrograde cholangiography in the treatment of choledocholithiasis. Surg Endosc. 2010;24(4):798-804. DOI: https://doi.org/10.1007/s00464-009-0659-0
Mohamed HMI, Abdallah AMA, Abd Elrazik MHE. Management of concomitant gallbladder and common bile duct stones: one stage versus two stages. Egypt J Surg. 2023;42(3):685-91. DOI: https://doi.org/10.4103/ejs.ejs_137_23
El-Geidie AA. Laparoendoscopic management of concomitant gallbladder stones and common bile duct stones: what is the best technique? Surg Laparosc Endosc Percutan Tech. 2011;21(4):282-7. DOI: https://doi.org/10.1097/SLE.0b013e3182218908
Gantois D, Goudard Y, Bourgouin S, Pauleau G, de La Villéon B, Balandraud P. One-stage laparoscopic procedure versus two-stage procedure in the management of common bile duct stones in patients aged 75 and more. J Visc Surg. 2020;157(2):99-106. DOI: https://doi.org/10.1016/j.jviscsurg.2019.08.007
Liu J-g, Wang Y-j, Shu G-m, Lou C, Zhang J, Du Z. Laparoscopic versus endoscopic management of choledocholithiasis in patients undergoing laparoscopic cholecystectomy: a meta-analysis. J Laparoendosc Adv Surg Tech. 2014;24(5):287-94. DOI: https://doi.org/10.1089/lap.2013.0546
Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L, et al. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. 2013;2013(12):CD003327.. DOI: https://doi.org/10.1002/14651858.CD003327.pub3
Bansal VK, Misra MC, Rajan K, Kilambi R, Kumar S, Krishna A, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial. Surg Endosc. 2014;28(3):875-85. DOI: https://doi.org/10.1007/s00464-013-3237-4
Welsh S, Nassar AHM, Sallam M. The incidence, operative difficulty and outcomes of staged versus index admission laparoscopic cholecystectomy and bile duct exploration for all comers: a review of 5750 patients. Surg Endosc. 2022;36(11):8221-30. DOI: https://doi.org/10.1007/s00464-022-09272-0
Sutcliffe RP, Hollyman M, Hodson J, Bonney G, Vohra RS, Griffiths EA. Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients. HPB (Oxford). 2016;18(11):922-8. DOI: https://doi.org/10.1016/j.hpb.2016.02.012
Aleid A, Alhebshi ZA, Alhazmi ES, Alshehri RM, Almonawar A, Ahmed ZN, et al. Assessing the Impact of Laparoscopic Cholecystectomy on Satisfaction, Quality of Life, and Cost-Effectiveness in Saudi Patients With Gallstone Disease: A Comprehensive Cross-Sectional Analysis. Cureus. 2023;15(9):e45288. DOI: https://doi.org/10.7759/cureus.45288
Gu YX, Wang XY, Chen Y, Shao JX, Ni SX, Zhang XM, et al. Optimizing surgical outcomes for elderly gallstone patients with a high body mass index using enhanced recovery after surgery protocol. World J Gastrointest Surg. 2023;15(10):2191-200. DOI: https://doi.org/10.4240/wjgs.v15.i10.2191
Elbegawy MA, Mohamed AT, Elgazzar SA. Evaluation of laparoscopic common bile duct exploration versus intraoperative endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis. Egypt J Surg. 2022;41(3):1101-8.
Downloads
Published
How to Cite
Issue
Section
