Single-step laparoscopic surgery reduces postoperative morbidity in the management of gallstones

Table 2 Treatment protocol adopted in included trials

Ref.	LERV	No-LERV
Farid et al[13], 2024	Treated by a single-step procedure combining laparoscopic cholecystectomy and intraoperative endoscopic sphincterotomy	Treated by a two-step (sequential treatment) preoperative endoscopic sphincterotomy followed by laparoscopic cholecystectomy; scheduling for laparoscopic cholecystectomy in the control group ranged from within 8 weeks after preoperative ERCP
Lella et al[14], 2006	Patients in group A underwent a single-session procedure under general anesthesia, starting with intraoperative cholangiography to confirm duct stones; following this, a video duodenoscope was used for ERCP, facilitated by a surgeon-placed guidewire through the cystic duct for rapid papillary cannulation, sphincterotomy, and stone removal, after which cholecystectomy was completed	Treated with preoperative ERCP and EST using a traditional method of bile duct cannulation; all patients in the control group were scheduled for laparoscopic cholecystectomy within 24 hours to 48 hours after ERCP; No drugs for prophylactic prevention of post-ERCP pancreatitis were administered before the two procedures; treated by the same endoscopist with experience of 200 ERCPs a year
Morino et al[15], 2006	The intervention group underwent laparoscopic cholecystectomy associated with intraoperative ERCP and ES according to the rendezvous technique	Patients underwent a pre-op ERCP with endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy in the same hospital admission
Rábago et al[16], 2006	Intraoperative cholangiography during laparoscopic cholecystectomy, and if stones were found, an intraoperative ERCP was performed	Patients treated with the standard 2-step treatment, pre-op ERCP followed by laparoscopic cholecystectomy within the next 8 weeks, provided that no post-ERCP complication had occurred
Sahoo et al[17], 2014	Patients were treated with LC and intra-operative cholangiography, and when the diagnosis of choledocholithiasis was confirmed, patients had undergone one-step management by the laparo-endoscopic rendezvous technique; included patients were diagnosed with cholelithiasis and choledocholithiasis	Treated with the first stage of pre-operative ERCP and CBD clearance by standard technique, and a second step of a classical four-port laparoscopic cholecystectomy
Tzovaras et al[18], 2012	The intervention group was offered the 1-step LERV technique; only patients with a positive MRCP were included in the study	Patients treated with standard 2-step treatment; pre-op ERCP followed by laparoscopic cholecystectomy within the next 48 hours, provided that no post-ERCP complication had occurred

LERV: Laparoscopic-endoscopic rendezvous; ERCP: Endoscopic retrograde cholangiopancreatography; MRCP: Magnetic resonance cholangiopancreatography; LC: Laparoscopic cholecystectomy; CBD: Common bile duct; ES: Endoscopic sphincterotomy.