Single-stage surgical management versus conventional two-stage management for pediatric choledocholithiasis: A systematic review and meta-analysis.

In 30 seconds

This systematic review and random-effects meta-analysis compared single-stage with conventional two-stage management of choledocholithiasis in children. Eight retrospective cohort studies included 562 patients. Compared with two-stage management, laparoscopic cholecystectomy with laparoscopic common bile duct exploration (LC-LCBDE) was associated with fewer postoperative complications (OR: 0.21, [95% CI: 0.08, 0.60]) and shorter hospital stay (MD: -1.46 days, [95% CI: -2.35, -0.56]), but more additional procedures. Laparoscopic cholecystectomy with intraoperative ERCP was associated with shorter anesthesia duration, with no other significant differences reported.

Key findings

• LC-LCBDE was associated with fewer complications than two-stage management (OR: 0.21, [95% CI: 0.08, 0.60]).
• LC-LCBDE was associated with reduced pancreatitis (OR:0.27, [95% CI: 0.09, 0.88]) and shorter hospital stay (MD: -1.46 days, [95% CI: -2.35, -0.56]).
• Additional procedures were more frequent with LC-LCBDE (OR: 5.86, [95% CI: 1.05, 32.7]).
• LC-ERCP was associated with shorter anesthesia duration (MD: -25.5 min, [95% CI: -49.0, -2.0]); readmission rates did not differ between groups.

Why it matters

The findings suggest that single-stage approaches may offer different trade-offs in pediatric duct-stone management: LC-LCBDE was associated with fewer complications and shorter stays, but more additional procedures, while LC-ERCP mainly differed in anesthesia duration. These comparisons can inform multidisciplinary assessment of available approaches, while the retrospective evidence does not establish that one strategy is superior for all children.

What to keep in mind

All eight included studies were retrospective cohorts, so the comparisons are observational and may be affected by differences in patient selection or practice.