Single-Stage Management of Cholecystocholedocholithiasis: Outcomes of Laparoendoscopic Rendezvous and Laparoscopic Common Bile Duct Exploration at Two Experienced Centers.

Abstract

Background: Single-stage management of cholecystocholedocholithiasis can be performed by laparoendoscopic rendezvous (LERV) or laparoscopic common bile duct exploration (LCBDE). We describe outcomes at two experienced centers, each preferentially using one approach.

Methods: We retrospectively studied patients treated between January 2016 and December 2023 at two tertiary centers. Baseline characteristics, intraoperative outcomes, and postoperative outcomes were described by institutional approach. An exploratory subgroup analysis compared transcystic and transductal LCBDE with LERV. Continuous variables were compared using the Mann-Whitney U test for two groups and the Kruskal-Wallis test for three groups; categorical variables were compared using chi-square or Fisher's exact tests, as appropriate.

Results: A total of 347 patients were included (LCBDE: 169; LERV: 178). LERV patients were older and had higher ASA classification (p < 0.001). Median operative time was 178minutes in LCBDE and 100.5minutes in LERV (p < 0.001). Ductal clearance exceeded 95% in both cohorts. Thirty-day morbidity was 10.7% and 11.2%, respectively (p = 0.862). Median postoperative length of stay was 1 and 2 days, respectively (p < 0.001). Because each center preferentially used one approach, differences in time and stay cannot be attributed to technique alone. Exploratory analysis of transcystic (n = 121) and transductal (n = 48) LCBDE alongside LERV (n = 178) showed differences in operative time and postoperative length of stay. These subgroups differed in anatomy and case complexity. Late biliary events were uncommon, but follow-up duration differed between centers.

Conclusions: Both experienced centers achieved high ductal clearance and low postoperative morbidity using their established single-stage approach. Operative time and postoperative length of stay describe outcomes within each institutional practice; this design does not isolate the effect of either technique. Selection should consider biliary anatomy, stone characteristics, and team expertise.