Laparoscopic common bile duct exploration versus preoperative endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy for choledocholithiasis: a narrative review

Choledocholithiasis, or common bile duct (CBD) stones, occurs in approximately 10–15% of patients with symptomatic cholelithiasis and remains a frequent indication for biliary intervention. Two main strategies are used to manage preoperatively identified or suspected CBD stones: a single-stage approach with laparoscopic common bile duct exploration (LCBDE) and a two-stage approach using preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). Despite multiple comparative studies, controversy persists regarding the optimal strategy due to differences in reported efficacy, complication profiles, resource utilization, and institutional expertise. This narrative review summarizes the current evidence comparing ductal clearance, complications, hospital length of stay, overall cost efficacy, technical and institutional considerations, and patient satisfaction outcomes between LCBDE and ERCP + LC.