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The aim of this study was to compare the results of 3 treatment methods for common bile duct (CBD) and gallbladder stones: open, 2-stage endoscopic-laparoscopic, and 1-stage laparoscopic CBD exploration. Materials and Methods: A total of 229 patients with a median age of 59 years (range: 9–92 years) were enrolled in this study. All of the patients had symptomatic gallbladder stone or CBD stones, which were found preoperatively or intraoperatively using ultrasonography, magnetic resonance-cholangiography, intraoperative contrast cholangiography, or fiberoptic choledochoscopy. Three methods of management of patients were employed. The classic open approach, which consists of laparotomy, cholecystectomy, and CBD exploration was used in 78 patients. The 2-stage laparo-endoscopic approach, which includes preor postoperative endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy, was performed in 84 patients. One-stage laparoscopic management consists of laparoscopic cholecystectomy and CBD exploration with intraoperative cholangiography and fiberoptic choledochoscopy, and was performed in 67 patients. Results: Operation time in the open approach, laparo-endoscopic, and 1-stage laparoscopic patients was 121 minutes, 142 minutes, and 123 minutes, respectively. The stone removal rate was comparable in the 3 groups: 94.8%, 85.7%, and 97% for open, laparo-endoscopic, and 1-stage laparoscopic patients, respectively. The hospital stay was significantly shorter in the 1-stage laparoscopic group (2.3 days in 1-stage laparoscopic, 6.5 days in laparo-endoscopic, and 8.2 days in open approach group). A significant difference was also found in the complication rate. The total number of complications (19.4%) in the 1-stage laparoscopic group was significantly (p<0.05) lower than in the open (52.5%) and laparo-endoscopic (33.3%) groups. Most complications (92.5%) in the 1-stage laparoscopic group were minor and did not require intervention. Conclusion: In comparison with the open and 2-stage laparo-endoscopic approaches, 1-stage laparoscopic cholecystectomy and CBD exploration have advantages, including shorter operative time, shorter hospital stay, lower complication rate, and greater stone removal rate, and may be considered the first choice for treatment of gallbladder and CBD stones.

Comparison of open, laparo-endoscopic and one-stage laparoscopic approaches for treatment of gallbladder and common bile duct stones