{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:47:30Z","timestamp":1793393250901,"version":"4.5.0"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009827","name":"Alexandria University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009827","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Over the past 20 years, one-stage laparoscopic common bile duct exploration (LCBDE) combined with laparoscopic cholecystectomy (LC) has gained wide acceptance for the management of cholecystocholedocholithiasis (CCL). Despite this, the two-stage endo-laparoscopic approach, consisting of endoscopic retrograde cholangiopancreatography (ERCP) followed by LC, remains the most commonly used strategy. This study aims to analyze the efficacy of one-stage laparoscopic management versus two-stage endo-laparoscopic management of CCL.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This study included 100 patients with CCL, with data collected retrospectively for those admitted between January 2018 and December 2020, and prospectively between January 2021 and June 2021 at the Surgical Department of the Medical Research Institute Hospital, University of Alexandria. Patients were divided into two groups: Group A, who underwent two-stage management (ERCP followed by LC), and Group B, who underwent one-stage management (LCBDE and LC). Outcomes compared included procedural success, duration, hospital stay, and cost.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>In our economic analysis, the one-stage laparoscopic strategy demonstrated substantially lower costs ($3,636) compared to the two-stage approach ($5,682), representing a savings of $2,046 per patient. Procedural failure and conversion to open surgery occurred in 4% of Group B patients (2 cases) compared to 8% of Group A patients (4 cases). The median duration of the one-stage procedure was longer at 155\u00a0min compared to 95\u00a0min for the two-stage procedure. Hospital stay was comparable, with a median of 3 days in both groups. Readmissions were rare, with no cases in the one-stage group and one case in the two-stage group.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The one-stage laparoscopic approach for managing CBD stones and gallstones offers substantial cost savings compared to the two-stage approach ($2,046 per patient). This approach presents a viable option for healthcare systems that prioritize resource efficiency.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12893-025-03094-2","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T06:00:26Z","timestamp":1753855226000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The efficacy of one-stage laparoscopic versus two-stage endo-laparoscopic management of cholecystocholedocholithiasis"],"prefix":"10.1186","volume":"25","author":[{"given":"Medhat","family":"Anwar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaimaa Abdelaziz","family":"Abdelmoneim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Hamida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Samir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Abu","family":"Deeba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdy","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Hany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"Torensma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Hefzy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"3094_CR1","doi-asserted-by":"crossref","unstructured":"Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L et al. Surgical versus endoscopic treatment of bile duct stones. In: The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2013. p. CD003327.pub3.","DOI":"10.1002\/14651858.CD003327.pub4"},{"key":"3094_CR2","doi-asserted-by":"publisher","first-page":"6076","DOI":"10.1007\/s00464-024-11139-5","volume":"38","author":"B Ramser","year":"2024","unstructured":"Ramser B, Coleoglou Centeno A, Ferre A, Thomas S, Brooke M, Pieracci F, et al. Laparoscopic common bile duct exploration is an effective, safe, and less-costly method of treating choledocholithiasis. Surg Endosc. 2024;38:6076\u201382.","journal-title":"Surg Endosc"},{"key":"3094_CR3","doi-asserted-by":"publisher","first-page":"1124955","DOI":"10.3389\/fsurg.2023.1124955","volume":"10","author":"S Nie","year":"2023","unstructured":"Nie S, Fu S, Fang K. Comparison of one-stage treatment versus two-stage treatment for the management of patients with common bile duct stones: A meta-analysis. Front Surg. 2023;10:1124955.","journal-title":"Front Surg"},{"key":"3094_CR4","doi-asserted-by":"crossref","unstructured":"Rogers SJ, Cello JP, Horn JK, Siperstein AE, Schecter WP, Campbell AR et al. Prospective randomized trial of LC\u2009+\u2009LCBDE vs ERCP\/S\u2009+\u2009LC for common bile duct stone disease. Arch Surg. 2010;145.","DOI":"10.1001\/archsurg.2009.226"},{"key":"3094_CR5","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1007\/s00464-013-3237-4","volume":"28","author":"VK Bansal","year":"2014","unstructured":"Bansal VK, Misra MC, Rajan K, Kilambi R, Kumar S, Krishna A, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial. Surg Endosc. 2014;28:875\u201385.","journal-title":"Surg Endosc"},{"key":"3094_CR6","unstructured":"Statement. on asa physical status classification system. 2020."},{"key":"3094_CR7","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","volume":"250","author":"PA Clavien","year":"2009","unstructured":"Clavien PA, Barkun J, De Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187\u201396.","journal-title":"Ann Surg"},{"key":"3094_CR8","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1089\/lap.2008.0428","volume":"19","author":"H Noble","year":"2009","unstructured":"Noble H, Tranter S, Chesworth T, Norton S, Thompson MA, Randomized. Clinical trial to compare endoscopic sphincterotomy and subsequent laparoscopic cholecystectomy with primary laparoscopic bile duct exploration during cholecystectomy in higher risk patients with choledocholithiasis. J Laparoendosc Adv Surg Tech. 2009;19:713\u201320.","journal-title":"J Laparoendosc Adv Surg Tech"},{"key":"3094_CR9","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1007\/s11605-014-2467-7","volume":"18","author":"G Ding","year":"2014","unstructured":"Ding G, Cai W, Qin M. Single-stage vs. two-stage management for concomitant gallstones and common bile duct stones: a prospective randomized trial with long-term follow-up. J Gastrointest Surg. 2014;18:947\u201351.","journal-title":"J Gastrointest Surg"},{"key":"3094_CR10","doi-asserted-by":"publisher","first-page":"1683","DOI":"10.1007\/s00464-022-09723-8","volume":"37","author":"J Zhu","year":"2023","unstructured":"Zhu J, Wang G, Xie B, Jiang Z, Xiao W, Li Y. Minimally invasive management of concomitant gallstones and common bile duct stones: an updated network meta-analysis of randomized controlled trials. Surg Endosc. 2023;37:1683\u201393.","journal-title":"Surg Endosc"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-025-03094-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12893-025-03094-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-025-03094-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T07:26:21Z","timestamp":1757316381000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcsurg.biomedcentral.com\/articles\/10.1186\/s12893-025-03094-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,30]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3094"],"URL":"https:\/\/doi.org\/10.1186\/s12893-025-03094-2","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,30]]},"assertion":[{"value":"11 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from participants. The study conformed to the principles of the Declaration of Helsinki and was approved by the ethical committee of the Medical Research Institute, University of Alexandria, under number\/438\/dec\/2020.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"325"}}