Ann Hepatobiliary Pancreat Surg.  2025 Feb;29(1):55-61. 10.14701/ahbps.24-157.

Single-stage laparoendoscopic management of cholecystocholedocholithiasis: A retrospective study comparing starting with ERCP versus with laparoscopic cholecystectomy

• M. Sayed M
• Abdelmohsen AS
• Ibrahim M
• Raafat M

• KMID: 2565407
• DOI: http://doi.org/10.14701/ahbps.24-157

Abstract

Backgrounds/Aims
Endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) remains the most common therapeutic strategy used for cholecystocholedocholithiasis (CCL). Recently, single-stage ERCP + LC has gained popularity for treating CCL due to patient satisfaction and financial considerations. In this study, we aimed to compare the feasibility and efficacy of the two variants of single-stage ERCP + LC (starting with ERCP followed by LC versus starting with LC followed by ERCP) for treatment of CCL.
Methods
A total of 115 patients who underwent single-stage ERCP + LC for CCL from January 2021 to December 2023 were enrolled in a retrospective comparative cohort study. These patients were divided into two groups: Group A (ERCP-first approach) and Group B (LC-first approach).
Results
Patients in Group A had a common bile duct clearance rate of 88.2%, which was comparable to the 95.7% observed in Group B (p = 0.163). The mean duration of the ERCP procedure was comparable between the two groups (43.3 ± 11.8 vs 39.5 ± 13.5 minutes; p = 0.112). However, the mean duration of the LC procedure was significantly longer in Group A than in Group B (41.2 ± 8.98 vs 37.2 ± 12.2 minutes; p = 0.045). The mean total operative time for the combined ERCP + LC was significantly longer in Group A compared to Group B (81.9 ± 16.7 vs 75.1 ± 19.3 minutes; p = 0.046). Post-ERCP pancreatitis occurred in 4 patients in Group A and in 2 patients in Group B (p = 0.701).
Conclusions
Both LC-1st approach and ERCP-1st approach are feasible and highly effective for treating CCL through single-stage ERCP + LC. However, the LC-1st approach has the advantage of a shorter operative time.

Keyword

Endoscopic retrograde cholangiopancreatography; Laparoscopic cholecystectomy; Cholecystocholedocholithiasis; Common bile duct stones

Reference

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