To study the overall efficacy and postoperative complications of "one-step" and sequential "two-step" laparoscopic surgery for cholecystolithiasis combined with choledocholithiasis.

A total of 103 patients with calculi admitted from May 2020 to May 2022 were included and divided into one-step group (n=48) and two-step group (n=55) according to treatment methods. The one-step group was treated with laparoscopic choledochotomy (LCBDE) combined with laparoscopic cholecystectomy (LC). In the two-step group, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic duodenal papillary sphincterotomy (EST) combined with LC were performed. All patients' data were scored by propensity matching (caliper value: 0.02) to exclude the influence of confounding factors of baseline data, and 46 patients with comparable baseline data were obtained in each group. The data were analyzed using SSPS 24.0 software, and the statistical data were expressed as [n (%)] and χ² test was used. Measurement data were expressed as () using paired t test or LSD-t test. P<0.05 indicated that the difference was statistically significant.

There was no significant difference in one-time stone clearance rate (93.5% vs. 91.3%), conversion to laparotomy rate (0.0% vs. 2.2%), stone residual rate (6.5% vs. 8.7%) and gastrointestinal function between the two groups during operation (P>0.05). There was no significant difference in the improvement time of gastrointestinal function between the two groups (P>0.05). The rate of sedative use and length of hospital stay in one-step group were significantly lower than those in two-step group (P<0.05). There was no significant difference in the incidence of complications during operation between the two groups (8.7% vs. 10.9%) (P>0.05).

LCBDE combined with LC in the treatment of cholecystolithiasis combined with choledocholithiasis has a faster postoperative recovery, which is suitable for young patients or patients with large stones, but ERCP/EST+LC can be selected for elderly patients or patients with severe obstructive gangrene. Therefore, the appropriate minimally invasive treatment plan should be selected according to the actual situation of patients.