One- and Two-Stage Approaches to Common Duct Stones.

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Surgical Innovation

Background:

• Cholelithiasis affects over 30% of the US population, with 10-20% developing choledocholithiasis.
• Historically managed with open surgery, choledocholithiasis treatment evolved to a two-stage laparoendoscopic approach.
• Advancements in endoscopy and minimally invasive surgery continue to shape treatment paradigms.

Purpose of the Study:

• To review the evolving management strategies for choledocholithiasis.
• To compare the efficacy and patient outcomes of different treatment approaches.
• To identify barriers and future research directions in choledocholithiasis management.

Main Methods:

• Literature review of studies from 2005 to 2025 focusing on choledocholithiasis management.
• Analysis of single-stage approaches: intraoperative ERCP, rendezvous endoscopy, and laparoscopic common bile duct exploration.
• Comparison of outcomes including morbidity, hospital stay, and stone clearance rates.

Main Results:

• Single-stage intraoperative ERCP at laparoscopic cholecystectomy significantly decreases 30-day morbidity and shortens hospital stays versus two-stage methods.
• Intraoperative rendezvous endoscopy avoids post-ERCP pancreatitis, improving patient morbidity.
• Laparoscopic common bile duct exploration demonstrates superior stone clearance, reduced costs, and shorter hospital stays compared to ERCP.

Conclusions:

• Single-stage approaches offer significant advantages in managing choledocholithiasis.
• Barriers to implementing advanced techniques include surgeon training and resource availability.
• Future research should explore robotic surgery and compare patient-centered outcomes of single-stage methods.