How can recovery be enhanced after single-stage laparoscopic management of CBD stones? Endoscopic treatment versus laparoscopic surgery

Background Single-stage management of CBD stones comprises simultaneous common bile duct (CBD) clearance and cholecystectomy. The CBD can be cleared by using endoscopic treatment (ET) or laparoscopic surgery (LS) alone. Aims To determine the most rapid recovery after the single-stage laparoscopic management of CBD stones. Methods Patients with CBD stones treated at either of two centers (one performing ET only and one performing LS only for single-stage treatment) were included. The primary endpoint was “the textbook outcome”. Results The feasibility rate was 74% for ET and 100% for LS ( p ≤ 0.001). The proportion of cases with the textbook outcome was higher in the ET group than in the LS-only group (73% vs. 10%; p 0.001). The CBD clearance rate was similar in the ET and LS-only groups (100% vs. 96.6%, respectively; p = 0.17 ). The overall morbidity rate was lower in the ET group than in the LS-only group (23% vs. 29%, p = 0.05). Conclusion and relevance Both ET and LS are feasible, safe and effective for clearance of the CBD. ET was better than LS in terms of a less frequent requirement for drainage and a shorter length of hospital stay. LS was associated with a shorter operating time.