Single-Stage Versus Two Stage Management for Choledocholithiasis: A Meta-Analysis of Randomized Controlled Trials with Subgroup Analysis by Follow-up Duration

Hosam Hadi Awaji; Abdallah Ali M Alahmary; Haya Mohammed Alsubaie; Lulwah Hussam Al Alshaikh; Jori Khalid Albarrak; Maryam Salah Albalawi; Amjed Hamdan Salem Alatawi; Bader Ghanem Aldhafeeri; Abdulrahman Mohammed Alghamdi

doi:10.24911/IJMDC.51-1785335623

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Online Published: 09 Sep 2026

IJMDC. 2026; 10(7):

doi: 10.24911/IJMDC.51-1785335623

Single-Stage Versus Two Stage Management for Choledocholithiasis: A Meta-Analysis of Randomized Controlled Trials with Subgroup Analysis by Follow-up Duration

Hosam Hadi Awaji, Abdallah Ali M Alahmary, Haya Mohammed Alsubaie, Lulwah Hussam Al Alshaikh, Jori Khalid Albarrak, Maryam Salah Albalawi, Amjed Hamdan Salem Alatawi, Bader Ghanem Aldhafeeri, Abdulrahman Mohammed Alghamdi.

Abstract
Optimal surgical strategy for choledocholithiasis is still open to debate. This meta-analysis compares the efficacy and safety of single-stage laparoscopic cholecystectomy with common bile duct exploration (LC+LCBDE) versus two-stage endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy (ERCP±EST+LC). A systematic search of MEDLINE/PubMed, Cochrane CENTRAL, Web of Science, ProQuest, ClinicalTrials.gov, Scopus, and grey literature was performed for English articles from inception to 14th December 2025. Sixteen RCTs, with a total of 1,646 patients, were included. The primary outcomes of interest were stone clearance and residual stones. Secondary outcomes of interest included need for reintervention, overall complications, bile leak, operative time, and hospital stay. Pooled risk ratios (RR) or mean differences (MD) were calculated with their 95% confidence intervals (CI). Subgroup analyses stratified outcomes into short-term and long-term follow-up. Single-stage management demonstrated superior stone clearance in short-term follow-up [RR 1.03, 95% CI 1.00–1.06, p=0.02]; however, it was associated with a significantly higher risk regarding bile leak [RR 4.45, 95% CI 2.37–8.36, p<0.00001]. The requirement for reintervention was significantly less with the single-stage approach [RR 0.25, 95% CI 0.13–0.46, p<0.0001]. There were no overall differences regarding complication rates. Operative time was prolonged with single-stage surgery [MD 28.89 min, p=0.03], and hospital stay did not clearly show any difference, with significant heterogeneity. Single-stage LC+LCBDE offers higher initial duct clearance and reduces subsequent procedures but at the cost of increased bile leak risk. Accordingly, the choice of strategy should balance the superior efficacy against this procedural hazard.

Key words: Choledocholithiasis, Laparoscopic common bile duct exploration, Endoscopic retrograde cholangiopancreatography, Meta-analysis.

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Pubmed Style

Awaji HH, Alahmary AAM, Alsubaie HM, Alshaikh LHA, Albarrak JK, Albalawi MS, Alatawi AHS, Aldhafeeri BG, Alghamdi AM. Single-Stage Versus Two Stage Management for Choledocholithiasis: A Meta-Analysis of Randomized Controlled Trials with Subgroup Analysis by Follow-up Duration. IJMDC. Online First: 09 Sep, 2026. doi:10.24911/IJMDC.51-1785335623

Web Style

Awaji HH, Alahmary AAM, Alsubaie HM, Alshaikh LHA, Albarrak JK, Albalawi MS, Alatawi AHS, Aldhafeeri BG, Alghamdi AM. Single-Stage Versus Two Stage Management for Choledocholithiasis: A Meta-Analysis of Randomized Controlled Trials with Subgroup Analysis by Follow-up Duration. https://www.ijmdc.com/?mno=329434 [Access: September 11, 2026]. doi:10.24911/IJMDC.51-1785335623

AMA (American Medical Association) Style

Awaji HH, Alahmary AAM, Alsubaie HM, Alshaikh LHA, Albarrak JK, Albalawi MS, Alatawi AHS, Aldhafeeri BG, Alghamdi AM. Single-Stage Versus Two Stage Management for Choledocholithiasis: A Meta-Analysis of Randomized Controlled Trials with Subgroup Analysis by Follow-up Duration. IJMDC. Online First: 09 Sep, 2026. doi:10.24911/IJMDC.51-1785335623

Vancouver/ICMJE Style

Awaji HH, Alahmary AAM, Alsubaie HM, Alshaikh LHA, Albarrak JK, Albalawi MS, Alatawi AHS, Aldhafeeri BG, Alghamdi AM. Single-Stage Versus Two Stage Management for Choledocholithiasis: A Meta-Analysis of Randomized Controlled Trials with Subgroup Analysis by Follow-up Duration. IJMDC, [cited September 11, 2026]; Online First: 09 Sep, 2026. doi:10.24911/IJMDC.51-1785335623

Harvard Style

Awaji, H. H., Alahmary, . A. A. M., Alsubaie, . H. M., Alshaikh, . L. H. A., Albarrak, . J. K., Albalawi, . M. S., Alatawi, . A. H. S., Aldhafeeri, . B. G. & Alghamdi, . A. M. (2026) Single-Stage Versus Two Stage Management for Choledocholithiasis: A Meta-Analysis of Randomized Controlled Trials with Subgroup Analysis by Follow-up Duration. IJMDC, Online First: 09 Sep, 2026. doi:10.24911/IJMDC.51-1785335623

Turabian Style

Awaji, Hosam Hadi, Abdallah Ali M Alahmary, Haya Mohammed Alsubaie, Lulwah Hussam Al Alshaikh, Jori Khalid Albarrak, Maryam Salah Albalawi, Amjed Hamdan Salem Alatawi, Bader Ghanem Aldhafeeri, and Abdulrahman Mohammed Alghamdi. 2026. Single-Stage Versus Two Stage Management for Choledocholithiasis: A Meta-Analysis of Randomized Controlled Trials with Subgroup Analysis by Follow-up Duration. International Journal of Medicine in Developing Countries, Online First: 09 Sep, 2026. doi:10.24911/IJMDC.51-1785335623

Chicago Style

Awaji, Hosam Hadi, Abdallah Ali M Alahmary, Haya Mohammed Alsubaie, Lulwah Hussam Al Alshaikh, Jori Khalid Albarrak, Maryam Salah Albalawi, Amjed Hamdan Salem Alatawi, Bader Ghanem Aldhafeeri, and Abdulrahman Mohammed Alghamdi. "Single-Stage Versus Two Stage Management for Choledocholithiasis: A Meta-Analysis of Randomized Controlled Trials with Subgroup Analysis by Follow-up Duration." International Journal of Medicine in Developing Countries Online First: 09 Sep, 2026. doi:10.24911/IJMDC.51-1785335623

MLA (The Modern Language Association) Style

Awaji, Hosam Hadi, Abdallah Ali M Alahmary, Haya Mohammed Alsubaie, Lulwah Hussam Al Alshaikh, Jori Khalid Albarrak, Maryam Salah Albalawi, Amjed Hamdan Salem Alatawi, Bader Ghanem Aldhafeeri, and Abdulrahman Mohammed Alghamdi. "Single-Stage Versus Two Stage Management for Choledocholithiasis: A Meta-Analysis of Randomized Controlled Trials with Subgroup Analysis by Follow-up Duration." International Journal of Medicine in Developing Countries Online First: 09 Sep, 2026. Web. 11 Sep 2026 doi:10.24911/IJMDC.51-1785335623

APA (American Psychological Association) Style

Awaji, H. H., Alahmary, . A. A. M., Alsubaie, . H. M., Alshaikh, . L. H. A., Albarrak, . J. K., Albalawi, . M. S., Alatawi, . A. H. S., Aldhafeeri, . B. G. & Alghamdi, . A. M. (2026) Single-Stage Versus Two Stage Management for Choledocholithiasis: A Meta-Analysis of Randomized Controlled Trials with Subgroup Analysis by Follow-up Duration. International Journal of Medicine in Developing Countries, Online First: 09 Sep, 2026. doi:10.24911/IJMDC.51-1785335623

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