Comparison outcomes between laparoscopic choledocholithotripsy and laparoscopic cholecystectomy and preoperative endoscopic retrograde cholangiopancreatography with sphincterotomy and laparoscopic cholecystectomy in patients with choledocholithiasis and cholelithiasis: an up-to-date meta-analysis.

BACKGROUND

Laparoscopic choledocholithotripsy (or laparoscopic common bile duct exploration [LCBDE]) with laparoscopic cholecystectomy (LC) and preoperative endoscopic sphincterotomy (EST) followed by LC are established treatment strategies for concomitant choledocholithiasis and cholelithiasis. However, the comparative efficacy, safety, and cost-effectiveness of these 1-stage vs 2-stage approaches remain uncertain, particularly with recent advances in minimally invasive interventions.

METHODS

A systematic search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was conducted between January 2000 and December 2024. Randomized controlled trials (RCTs) comparing LCBDE + LC with EST + LC in patients with confirmed or suspected common bile duct (CBD) stones were included. Of note, 2 reviewers independently extracted data and assessed the risk of bias using the Cochrane Collaboration tool. Meta-analyses were performed using Review Manager software (version 5.4.1; Cochrane Informatics and Knowledge Management Department, Nordic Cochrane Centre) with random-effects models to calculate odds ratios (ORs) or mean differences (MDs) with 95% CIs. The study protocol was registered in the International Prospective Register of Systematic Reviews (registration number: CRD42024610284).

RESULTS

Overall, 16 RCTs involving 1576 patients were included (778 in the LCBDE + LC group and 798 in the EST + LC group). EST + LC achieved a higher CBD stone clearance rate (OR, 1.72 [95% CI, 1.14-2.60]; P =.01). No significant differences were observed in the overall complications (OR, 0.66 [95% CI, 0.42-1.03]; P =.07) or mortality (OR, 0.22 [95% CI, 0.02-1.93]; P =.17). LCBDE + LC resulted in lower recurrence (OR, 0.27 [95% CI, 0.11-0.69]; P =.006) and reduced costs (MD, -2059.35 United States dollar [95% CI, -2720.55 to -1398.16]; P <.00001). Hospital stay and residual stone rates were comparable between the 2 groups.

CONCLUSION

EST + LC provides a higher rate of CBD stone clearance, whereas LCBDE + LC offers advantages in reducing recurrence and overall costs. Both approaches are safe and effective. Treatment choice should be individualized based on institutional expertise, resource availability, and patient-specific considerations.