Single-stage versus two-stage ERCP and laparoscopic cholecystectomy for gallbladder stones with choledocholithiasis:...

The optimal treatment strategy for gallbladder stones with concurrent choledocholithiasis remains controversial. This study aims to compare the long-term prognosis of single-stage versus two-stage approaches combining endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC).

A retrospective cohort study was conducted from January 2020 to December 2022, including 120 patients with gallbladder stones and choledocholithiasis. Patients were divided into two groups: single-stage group (n = 57) underwent the single-stage procedure (simultaneous ERCP and LC), whereas two-stage group (n = 63) received the two-stage approach (ERCP followed by LC after 2-8 weeks). Perioperative parameters, early complications, stone recurrence, cholangitis recurrence, and quality of life were assessed using Gastrointestinal Quality of Life Index (GIQLI). Survival analysis was performed using Kaplan-Meier curves and log-rank tests.

Single-stage group demonstrated shorter total operative time (156.2 ± 28.5 vs. 189.7 ± 32.2 min, P < 0.001), reduced hospital stay (3.0 vs. 5.0 d, P < 0.001), and lower total medical costs (32,457 ± 4,235 vs. 38,789 ± 5,568 CNY, P < 0.001) compared to two-stage group. Both groups achieved comparable high success rates (96.5% vs. 96.8%) with similar blood loss and early complication rates (14.0% vs. 19.1%, P > 0.05). No mortality occurred in either group. During follow-up of 36 months, stone recurrence (12.3% vs. 14.3%) and cholangitis recurrence rates (8.8% vs. 11.1%) were similar between groups, with no significant differences in recurrence-free survival curves (P > 0.05). Quality of life assessment showed superior early recovery in single-stage group at one month postoperatively (GIQLI score: 85.1 ± 15.2 vs. 78.3 ± 9.8, P < 0.05), but both groups achieved equivalent long-term quality of life outcomes at 36 months follow-up (116.7 ± 12.5 vs. 115.2 ± 11.8, P > 0.05).

Both single-stage and two-stage approaches provide safe and effective treatment for gallbladder stones with choledocholithiasis. The single-stage strategy offers advantages in operative efficiency, hospital stay, cost-effectiveness, and early quality of life recovery, while maintaining comparable long-term recurrence rates and safety profiles.