Gallstones and common bile duct stones management: Single-stage vs two-stage treatment

Abstract

BACKGROUND

The optimal management of gallstones and common bile duct stones remains a subject of ongoing debate. The conventional two-stage treatment involves initial endoscopic retrograde cholangiopancreatography (ERCP) to clear the bile duct, followed by laparoscopic cholecystectomy. Alternatively, the single-stage laparoendoscopic rendezvous (LERV) procedure combines ERCP and laparoscopic cholecystectomy in the same surgical session.

AIM

To evaluate the efficacy, safety, and logistical considerations of these two approaches, emphasizing their implications for different healthcare settings.

METHODS

A literature search was conducted through a PubMed search (2010-2024) using the terms “laparoendoscopic rendezvous”, “endoscopic retrograde cholangiopancreatography”, and “cholecystocholedocholithiasis”. Only English-language studies were included.

RESULTS

In our analysis, LERV significantly reduced the incidence of post-ERCP pancreatitis by 67% (2.4% vs 8.8%) and shortened hospital stay by a mean of up to 6 days. Stone clearance rates were comparable between LERV (97%) and the two-stage approach (96%). Although LERV was associated with a longer operative time (139.8 minutes vs 107.7 minutes), it demonstrated lower overall costs, largely due to reduced hospitalization. Rates of postoperative bleeding, cholangitis, and bile leak were low and did not differ significantly between groups.

CONCLUSION

The single-stage LERV approach is safe, effective, and associated with lower pancreatitis rates, shorter hospital stays, and reduced costs compared to the two-stage strategy. Its implementation, however, requires coordinated surgical-endoscopic expertise, making it most suitable for well-equipped centers and carefully selected patients.

Keywords: Laparoendoscopic rendezvous; Gallstones; Endoscopic retrograde cholangiopancreatography; Common bile duct stones; Laparoscopic cholecystectomy

Core Tip: The conventional two-stage approach separates endoscopic and surgical interventions, whereas the single-stage laparoendoscopic rendezvous procedure provides a more streamlined alternative. This study highlights the advantages of laparoendoscopic rendezvous, including shorter hospital stay, a reduced risk of post-endoscopic retrograde cholangiopancreatography pancreatitis, and improved bile duct clearance. Furthermore, we examine its feasibility across various healthcare settings, particularly in low-volume centers, where procedural consolidation could enhance outcomes. Future studies should focus on refining patient selection and evaluating long-term benefits to optimize clinical practice.