To systematically evaluate the safety and efficacy of laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) and LC combined with endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) in the treatment of gallbladder stones complicated with common bile duct stones.

Literature review was performed from CNKI, VIP and Wanfang Data, PubMed, Embase, Medline and Cochrane Library using the searching keywords of gallbladder stones, common bile duct stones, endoscopy, duodenal sphincterotomy, laparoscopic choledochotomy in both English and Chinese from January 1, 2005 to January 1, 2022. According to the inclusion and exclusion criteria, two researchers screened the retrieved literatures and extracted data. Meta-analysis was conducted by RevMan 5.4 software.

1 701 patients from 11 RCTs were included, including 883 patients in the LC + LCBDE group and 818 in the ERCP/EST + LC group. No significant differences were observed in stone clearance rate (OR=0.85, 95%CI: 0.59-1.22) and surgical conversion rate (OR=1.46, 95%CI: 0.81-2.62) between two groups (P>0.05). No significant differences were noted in the operation time (WMD=11.26, 95%CI: -13.38-35.89) and length of hospital stay (WMD=-0.65, 95%CI: -1.55-0.16) between two groups (P>0.05). The incidence of postoperative bile leakage (OR=4.89, 95%CI: 2.13-11.21) and pancreatitis (OR=0.15, 95%CI: 0.06-0.37) significantly differed between two groups (P<0.05).

Both two surgical procedures are safe and effective treatment for gallbladder stones complicated with common bile duct stones. The incidence of pancreatitis after LC combined with LCBDE is lower, whereas the incidence of bile leakage after LC combined with ERCP/EST is lower.