Comparative Effectiveness of Single-Stage Laparoscopic Common Bile Duct Exploration Plus Cholecystectomy Versus Staged ERCP/EST Plus Cholecystectomy for Cholecystocholedocholithiasis: A Propensity Score-Matched Retrospective Cohort Study

Abstract Background The optimal strategy for patients with concomitant gallbladder and common bile duct stones remains debated. This study compared single-stage laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE + LC) with staged endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy plus LC (ERCP/EST + LC). Methods We conducted a retrospective cohort study including 598 analyzable patients (299 per group). Propensity scores were estimated from sex, age, body mass index, white blood cell count, total bilirubin, alanine aminotransferase, maximum stone diameter, and common bile duct diameter. One-to-one nearest-neighbor matching produced 206 matched pairs. Paired continuous outcomes were compared using the Wilcoxon signed-rank test, paired binary outcomes using the exact McNemar test, and odds ratios for binary outcomes using conditional logistic regression stratified by matched pair. Results After matching, most covariates were balanced, although mild residual imbalance remained in total bilirubin, common bile duct diameter, and maximum stone diameter. Median total procedural time was shorter with LCBDE + LC than with ERCP/EST + LC [150.0 (115.0-195.0) vs 177.0 (159.2–193.0) min; P < 0.001], and total hospitalization cost was lower [2.99 (2.55–3.63) vs 4.04 (3.36–4.70) ×10⁴ CNY; P < 0.001]. Median hospital stay was longer in the LCBDE + LC group [14.0 (12.0–17.0) vs 11.0 (8.0–13.0) days; P < 0.001]. No statistically significant differences were detected in conversion to open surgery, incomplete stone clearance, intra-abdominal infection, biliary bleeding, postoperative pancreatitis, postoperative cholangitis, or bile leakage. The median SSQ-8 score was higher with LCBDE + LC [86.0 (83.0–90.0) vs 82.0 (79.0–86.0); P < 0.001]. Conclusions In this propensity score-matched cohort, LCBDE + LC was associated with shorter cumulative procedural time, lower hospitalization cost, and higher patient satisfaction, with similar observed rates of stone clearance and major complications compared with ERCP/EST + LC. The longer hospital stay and residual covariate imbalance warrant cautious interpretation and external validation.