Single-stage versus two-stage ERCP and laparoscopic cholecystectomy for gallbladder stones with choledocholithiasis: a retrospective cohort study with long-term prognostic comparative analysis

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.