One-stage versus two-stage ERCP followed by laparoscopic cholecystectomy for the management of pediatric choledocholithiasis: A systematic review and meta-analysis.

BACKGROUND

The optimal approach to managing pediatric choledocholithiasis remains a subject of ongoing debate. Both single-stage strategies, combining laparoscopic cholecystectomy (LC) with bile duct clearance via intraoperative ERCP and sphincterotomy, and two-stage approaches, typically involving preoperative ERCP followed by interval LC, are widely employed. While prior meta-analyses in predominantly adult populations suggest comparable safety profiles between these strategies, pediatric-specific data remain lacking in consensus.

METHODS

We performed a systematic review and meta-analysis of studies comparing one-stage versus two-stage management of pediatric choledocholithiasis. Pubmed, Embase, and Cochrane Library were searched up to July 2025. Pooled estimates were calculated with risk ratios (RR) and mean differences (MD) using random-effects models in RevMan Web.

RESULTS

We included three studies with 165 patients. One-stage management was associated with a significant reduction in anesthesia time compared with the two-stage approach (MD -25.23 min; 95 % CI -48.07 to -2.38; p = 0.03; I2 = 67 %). No significant differences were observed for length of hospital stay (MD -0.71 days; 95 % CI -1.69 to 0.26; p = 0.15; I2 = 15 %), overall complications (RR 0.77; 95 % CI 0.30 to 1.94; p = 0.58; I2 = 0 %), or readmissions (RR 0.59; 95 % CI 0.12 to 3.05; p = 0.53; I2 = 22 %).

CONCLUSIONS

This systematic review and meta-analysis demonstrates that, in pediatric patients with choledocholithiasis, a single-stage approach-combining laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) under the same anesthetic session-significantly reduces cumulative anesthesia exposure without increasing the risk of postoperative complications, hospital length of stay, or readmission rates. These findings support the safety, efficiency, and resource optimization potential of the one-stage strategy compared to the conventional two-stage pathway in the context of pediatric surgical care.