Streamlining Choledocholithiasis Management: A Comparative Analysis of Efficiency, Recovery, and Patient-Centered Outcomes in Single-Stage versus Two-Stage Approaches

Background The optimal management strategy for choledocholithiasis remains debated. This study compared single-stage laparoscopic common bile duct exploration (LCBDE) with the conventional two-stage approach—endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy (ERCP+LC)—focusing on efficiency, recovery, and patient-centered outcomes. Methods A prospective randomized study was conducted on 200 patients with concomitant gallbladder and bile duct stones, equally allocated to LCBDE or ERCP+LC groups. Operative parameters, postoperative pain, complications, hospital stay, and satisfaction were analyzed (p<0.05). Results Both groups achieved comparable duct clearance (LCBDE 98% vs ERCP+LC 97%, p=0.65). LCBDE showed significantly lower pain at 24 hours (p=0.01) and day 3 (p=0.02), with faster recovery and earlier return to activity. Mean hospital stay was shorter after LCBDE (6.0 ± 2.0 vs 6.5 ± 2.3 days, p=0.20). Multivariate analysis identified ERCP as an independent predictor of prolonged stay (+0.8 days; p=0.008). Major complications were slightly lower with LCBDE (3% vs 5%, p=0.47). Economic analysis revealed a 40–45% cost reduction with the single-stage approach. Conclusion LCBDE achieved equivalent duct clearance with significantly lower pain and shorter adjusted hospital stay, supporting its wider adoption as a safe, efficient, and cost-effective single-stage strategy for managing choledocholithiasis in experienced centers.