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

BackgroundLaparoscopic 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 methodsThis 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.ResultsBoth 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.ConclusionLC-intraERCP is safer and more effective than LC-LCBDE for treating cholecysto-choledocholithiasis. Moreover, it is associated with reduced hospital stay and cost.