Totally laparoscopic versus laparoendoscopic management of concomitant common bile duct and gallbladder stones: Randomized controlled study

Background
The current preferred technique in most institutes is endoscopic management of common bile-duct (CBD) stones followed by laparoscopic cholecystectomy (LC). This study addressed the success of totally laparoscopic versus laparoendoscopic management in patients with concomitant CBD and gallbladder stones.
Patients and methods
Between January 2019 and May 2020, consecutive patients diagnosed with concomitant CBD and gallbladder stones were randomized into two groups. Group-A patients underwent single-stage management of their stones via laparoscopic common bile-duct exploration (LCBDE) and LC, while group-B patients underwent endoscopic retrograde cholangiopancreatography (ERCP) followed by LC within 72 h. The primary endpoint was technique success, which was defined as successful biliary clearance and LC. Secondary outcomes included total operative duration, hospital stay, number of procedures per patient, and postoperative complications.
Results
A total of 122 patients were randomized into two groups: 54 patients in group A and 53 patients in group B were finally subjected to analysis after exclusion of protocol violators. Technique success was similar in both groups: 90.7% (49/54 patients) in the LCBDE+LC group versus 86.8% (46/53 patients) in the ERCP+LC group. The total operative duration was longer in the LCBDE+LC group than in the ERCP+LC group (140.5 ± 49.44 vs. 99.89 ± 49.16 min) and total hospital stay was longer in the LCBDE+LC group (2.33 ± 1.26 days) than in the ERCP+LC (1.87 ± 1.68 days). The number of procedures per patient was significantly shorter in the LCBDE+LC than in ERCP+LC (1.04 ± 0.19 vs. 1.89 ± 0.51 days). Both groups were matched for postoperative complications (22.2 and 20.75% in the LCBDE+LC and ERCP+LC groups, respectively).
Conclusion
Both groups were equally effective in managing concomitant CBD and gallstones with the same risk of complications. ERCP+LC had a shorter operative duration and hospital stay than LCBDE+LC, despite LCBDE+LC having fewer procedures per patient.