Laparoscopic one-stage (intraoperative-cholangiopancreatography / laparoscopic cholecystectomy or laparoscopic common bile duct exploration / laparoscopic cholecystectomy) vs. two-stage (pre-op cholangiopancreatography → laparoscopic cholecystectomy) for choledocholithiasis: a systematic review and meta-analysis

BACKGROUND: Given the limitations of previous meta-analyses and the rapid global expansion of advanced laparoscopic technology, there is a clear need for an updated systematic review focusing on recent evidence. This study aims to provide a comprehensive and contemporary synthesis comparing one-stage and two-stage laparoscopic approaches for the management of choledocholithiasis. MATERIALS AND METHODS: Subgroup and sensitivity analyses were performed to assess the stability and consistency of pooled outcomes across the included randomized controlled trials. Statistical synthesis was conducted using the Mantel–Haenszel method for categorical variables and the inverse-variance model for continuous outcomes under a fixed-effect framework. Heterogeneity was evaluated using Cochrane’s Q test and I² statistics, and potential publication bias was explored visually through funnel plots. All statistical procedures and graph generation were carried out using RevMan 5.4 software (Cochrane Collaboration, UK). RESULTS: A total of 12 randomized controlled trials involving 1,238 patients were included in this systematic review and meta-analysis comparing LC(laparoscopic cholecystectomy) + iERCP(intraoperative-Cholangiopancreatography )with LC(laparoscopic cholecystectomy) + pERCP(Pre-op Cholangiopancreatography )for choledocholithiasis. The success rate favored the one-stage approach (RR = 1.05 [0.97–1.09], I² = 19%, p = 0.29). Postoperative morbidity was significantly lower with iERCP (RR = 0.58 [0.35–0.95], Z = 2.14, p = 0.03, I² = 19%). The operative time was shorter in the two-stage strategy (MD = − 28.6 min [–45.2 to − 12.0], p = 0.0007, I² = 11%), while hospital stay was reduced with iERCP (MD = − 2.85 days [–3.92 to − 1.78], p < 0.001, I² = 17%). CONCLUSION: The one-stage laparoscopic–endoscopic approach (LC + iERCP) demonstrates superior efficacy and safety compared with the conventional two-stage strategy (LC + pERCP) for managing concurrent gallbladder and bile duct stones. By improving ductal clearance, reducing complications, and shortening hospitalization, it represents an optimized, patient-centered therapeutic option.