A meta-analysis of single-stage versus two-stage management for concomitant gallstones and common bile duct stones

Objective: To conduct a randomized controlled trial (RCT) meta-analysis to evaluate the safety and effectiveness of single-stage [laparoscopic cholecystectomy (LC) + laparoscopic common bile duct exploration (LCBDE)] vs. two-stage management [preoperative endoscopic retrograde cholangiopancreatography (ERCP) + LC] for concomitant gallstones and common bile duct stones. Methods: RCTs that met the inclusion criteria for data extraction were identified from electronic databases (PubMed, Embase, Science Citation Index, and the Cochrane Library) up to August 2014. The relevant congressional proceedings were also searched. The primary outcomes were stone clearance from the common bile duct, postoperative morbidity and mortality. The secondary outcomes were conversion to other procedures, length of hospital stay, total operative time, and hospitalization charges. The outcomes were calculated as odds ratios (ORs) with 95% confidence intervals (CIs) using RevMan 5.2. Results: Eight RCTs, which included 1130 patients, were identified for analysis in our study. The meta-analysis revealed that the common bile duct stone clearance rate in the single-stage group was higher (OR = 1.56, 95% CI: 1.05 to 2.33, P = 0.03). The lengths of hospital stay (MD = -1.02, 95% CI: -1.99 to -0.04, P = 0.04) and total operative times (MD = -16.78, 95% CI: -27.55 to -6.01, P = 0.002) were also shorter in the single-stage group. There was no statistically significant difference between the two groups regarding postoperative morbidity (OR = 1.12, 95% CI: 0.79 to 1.59, P = 0.52), mortality (OR = 0.29, 95% CI: 0.06 to 1.41, P = 0.13) and conversion to other procedures (OR = 0.82, 95% CI: 0.37 to 1.82, P = 0.62). Conclusion: Single- and two-stage management for cholecysto-choledocholithiasis had similar mortality and complication rates; however, the single-stage strategy was better in terms of stone clearance, hospital stay and total operative time. (C) 2015 Elsevier Masson SAS. All rights reserved.