Published: 2019-11-26

Two-stages using endoscopic retrograde cholangio-pancreatography procedures versus single stage laparoscopic management for concomitant gallstones and common bile duct stones

Ahmed Abdel Kahaar Aldardeer, Alaa A. Redwaan


Background: Laparoscopic common bile duct exploration (LECBD) has been proven to be a safe, reliable, and effective treatment for common bile duct (CBD) stones and has gained wider acceptance. Endoscopic retrograde cholangio-pancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is safe and efficient method that has been usually used for the treatment of bile duct stones. The aim of this study is to compare the outcome of management of concomitant gallstones and common bile duct by two stage (ERCP+LC) versus one stage (LECBD+LC).

Methods: This study included 150 patients with concomitant gallstones and CBD stones who were treated at sohag university hospital from July 2017 to December 2018. Results were statistically analysed.

Results: The success rates of laparoscopic CBD exploration and ERCP for clearance of CBD were similar (Group A 96% vs. Group B 97.3%). The mean operative time was significantly longer in-group A (125.7±36.6 min) vs. in-group B (82.4±27.6 min), Group A as regard intraoperative complications (one patient had hemorrhage) vs. group B (2 patients hemorrhage during lap. cholecystectomy). As for conversion to other procedure 2 patients for group A vs. 3 patients for group B (conversion of LC to open).

Conclusions: Single and two-stage management for uncomplicated concomitant gallbladder and CBD stones had similar success and complication rates, but the single stage strategy was better in terms of shorter hospital stay, need for fewer procedures, less morbidity, and allows earlier recovery with a reduced period of short-term disability. 


CBD stones, Gallstones, Laparoscopic CBD exploration, ERCP, Laparoscopic cholecystectomy

Full Text:



Duncan CB, Riall TS. Evidence-based current surgical practice: calculous gallbladder disease. J Gastrointestinal Surg. 2012;16:2011-25.‏

Costi R. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World J Gastroenterol. 2014;20:13382.‏

Sahoo MR, Kumar AT, Patnaik A. Randomised study on single stage laparo-endoscopic rendezvous (intra-operative ERCP) procedure versus two stage approach (Pre-operative ERCP followed by laparoscopic cholecystectomy) for the management of cholelithiasis with choledocholithiasis. J Minimal Access Surg. 2014;10:139.‏

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 Endoscopy. 2018;32:3763-76.‏

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 Endoscopy. 2014;28:875-85.‏

Peitzman AB, Watson GA, Marsh JW. Acute cholecystitis: when to operate and how to do it safely. J Trauma Acute Care Surg. 2015;78:1-12.‏

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;(9):CD003327.‏

Lee TH, Hwang SO, Choi HJ, Jung Y, Cha SW, Chung IK, et al. Sequential algorithm analysis to facilitate selective biliary access for difficult biliary cannulation in ERCP: a prospective clinical study." BMC Gastroenterol. 2014;14:30.‏

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 Surg. 2017;17:79.‏

Elgeidie A, Atif E, Elebidy G. Intraoperative ERCP for management of cholecystocholedocholithiasis. Surg Endoscopy. 2017;31:809-16.‏

Stanley, Henry Morton et al. The Autobiography of Sir Henry Morton Stanley, GCB. Cambridge University Press; 2011.

Nasrallah MM1, El-Shehaby AR, Salem MM, Osman NA, El Sheikh E, Sharaf El Din UA. Fibroblast growth factor-23 (FGF-23) is independently correlated to aortic calcification in haemodialysis patients. Nephrol Dial Transplant. 2010;25(8):2679-85.‏

Lu J, Cheng Y, Xiong XZ, Lin YX, Wu SJ, Cheng NS. Two-stage vs single-stage management for concomitant gallstones and common bile duct stones. World J Gastroenterol. 2012;18(24):3156–66.