Meta-analysis of randomized controlled trials comparing single-stage laparoscopic versus two-stage endoscopic management followed by laparoscopic cholecystectomy of preoperatively diagnosed common bile duct stones

Abstract

Background: Common bile duct stones are a significant public health issue that often requires surgical intervention. Two primary surgical techniques for addressing these conditions are laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) in 1 or 2 stages, respectively. This systematic review and meta-analysis compared the efficacy and results of these 2 techniques. Methods: A systematic review and meta-analysis of randomized clinical trials followed the PRISMA and AMSTAR 2 guidelines. Literature research were performed in the Cochrane Library, PubMed/MEDLINE, Embase, and Google Scholar up to March 1, 2023. Results: Fourteen studies with a total of 1849 patients were included. The success rate was similar between LCBDE (872/919 patients) and ERCP followed by LC (866/930 patients) (odds ratio [OR] = 1.31; 95% confidence interval [CI] [0.76, 2.25], P = .33). There was no significant difference in residual stones (OR = 0.71; 95% CI [0.28, 1.83], P = .48), mortality (OR = 0.55; 95% CI [0.14, 2.14], P = .39), morbidity (OR = 0.87; 95% CI [0.66, 1.16], P = .36) or hospital stay (mean difference = -1.31; 95% CI [-2.89, 0.26], P = .10) between the 2 groups. Meta-analysis found no significant differences between LCBDE and ERCP followed by LC in terms of success rate, residual stones, mortality, morbidity or hospital stay. Conclusion: Both techniques are viable options for the treatment of choledocholithiasis and gallbladder stones. More multicentric randomized controlled trials are recommended to confirm these findings and explore long-term outcomes.