254 One-Step versus Two-Step Management of Concomitant Cholelithiasis and Choledocholithiasis: A Comparative Analysis

Abstract Aim Choledocholithiasis affects 10-15% of individuals undergoing cholecystectomy, posing risks like pancreatitis and cholangitis. The debate between a one-step laparoscopic common bile duct exploration (LCBDE) and a two-step approach involving laparoscopic cholecystectomy followed by endoscopic retrograde cholangiopancreatography (ERCP) remains unresolved. This systematic review aims to determine the preferred approach based on available evidence. Method A systematic review of literature was conducted, sourcing unbiased data from PubMed, Embase, and ScienceDirect between 2010 and 2025 using MeSH terms and Boolean operators. Twenty-one publications were selected after relevant screening. Results LCBDE showed better stone clearance (84-100%) compared to ERCP (70%), and a shorter hospital stay (3.2 days vs. 9.1 days). Cost-effectiveness also favored LCBDE. While LCBDE had a higher bile leak rate (6.7%) compared to ERCP (3.3%), it had no reported cases of post-ERCP pancreatitis (2.6-16.7%) and it also demonstrated higher patient satisfaction. Conclusions This supports growing evidence that LCBDE offers improved efficacy, efficiency, and better patient outcomes and should be the default approach where expertise and facilities allow. Many UK trusts have already adopted LCBDE, and broader implementation is recommended.