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One-stage versus two-stage management for acute cholecystitis associated with common bile duct stones: a retrospective cohort study

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Abstract

Background

Both one-stage [laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE)] and two-stage [endoscopic retrograde cholangiopancreatography (ERCP) followed by sequential LC] approaches are effective treatment for concomitant common bile duct (CBD) stones and gallstone. Although many studies compared one-stage with two-stage surgical approach for cholecysto-choledocholithiasis, there are very few studies compared the two management strategies for acute cholecystitis (AC) associated with CBD stones.

Methods

Between January 2014 and December 2019, patients with concomitant AC and CBD stones proposed to early surgery were retrospectively studied. The patients were scheduled to undergo either the one-stage [LCBDE and LC (LCBDE+LC) were undertaken at the same operation] or two-stage [preoperative ERCP for CBD stone clearance was followed by LC 1–3 days later (pre-ERCP+LC)] procedure. The success rate of complete stone clearance, procedure-related complication, hospital stay, hospitalization charges and later biliary complications were compared between the two groups.

Results

Sixty patients were included in the study, 28 in the one-stage group and 32 in the two-stage group. There was no significant difference in the success rate of complete stone clearance (96.4% vs. 93.8%, P = 1.000), complication rate (10.7% vs. 9.4%, P = 1.000), incidence of pancreatitis (0 vs. 6.3%, P = 0.494) or length of hospital stay (12 ± 5 vs. 11 ± 4 days, P = 0.393) between the two groups.

Conclusion

For patients with concomitant AC and choledocholithiasis proposed to early surgery, both the one-stage (LCBDE+LC) and two-stage (pre-ERCP+LC) approaches were acceptable and broadly comparable in achieving clearance of CBD stones.

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Author notes

  1. Yong Yan and Yanhua Sha have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, 510220, China

    Yong Yan, Wei Yuan, Xuanjin Zhu & Bailin Wang

  2. Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China

    Yanhua Sha

  3. The First Medical College of Guizhou Medical University, Guiyang, 550004, China

    Hui Yuan

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  1. Yong Yan
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Correspondence to Bailin Wang.

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Yong Yan, Yanhua Sha, Wei Yuan, Hui Yuan, Xuanjin Zhu, and Bailin Wang have no conflicts of interest or financial ties to disclose.

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Yan, Y., Sha, Y., Yuan, W. et al. One-stage versus two-stage management for acute cholecystitis associated with common bile duct stones: a retrospective cohort study. Surg Endosc 36, 920–929 (2022). https://doi.org/10.1007/s00464-021-08349-6

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