Endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy versus laparoscopic common bile duct exploration and cholecystectomy for cholecysto-choledocholithiasis − The same operator: a multicenter randomized controlled trial

Abstract

Background Laparoscopic cholecystectomy (LC) plus either intraoperative endoscopic retrograde cholangiopancreatography (intraERCP) or laparoscopic common bile duct exploration (LCBDE) are one-stage, minimally invasive procedures to treat cholecysto-choledocholithiasis. This study aimed to compare the safety, efficacy, and surgical outcomes of the LC-intraERCP and LC-LCBDE for patients with cholecysto-choledocholithiasis. Both authors completely performed both procedures. Patients and methods This multicenter randomized controlled trial included 218 patients with cholecysto-choledocholithiasis randomized to LC-intraERCP (n = 109) and LC-LCBDE (n = 109) treatment groups between February 2019 and October 2022. The primary outcome was a technical success, while conversion to open surgery, operative time, morbidity, mortality, length of hospital stay, and cost were considered secondary outcomes. Results Both groups had no significant differences in success (94.5% for LC-intraERCP and 87.2% for LC-LCBDE) and morbidity rate. The conversion to open surgery, the mean operative time, the length of hospital stay, and the cost were significantly lower in the LC-intraERCP. There was no mortality in either group. Conclusion LC-intraERCP is safer and more effective than LC-LCBDE for treating cholecysto-choledocholithiasis. Moreover, it is associated with reduced hospital stay and cost.