Modern approach to cholecysto-choledocholithiasis

Table 1 Comparison of the available approaches to concomitant lithiasis of gallbladder and common bile duct

	Advantages	Disadvantages	Risks	Availability
Single-step
Open cholecystectomy and bile duct clearance	Highly effective	Highly invasive	Surgical complications, Kehr positioning	All hospitals
Fully laparoscopic cholecystectomy and bile duct clearance	Very effective	Highly less invasive	Kehr positioning	Few hospitals
Laparoscopic cholecystectomy and intraoperative endoscopic bile duct clearance	Very effective	Less invasive	Endoscopic complications	Few hospitals
Two-step
Preoperative endoscopic bile duct clearance and sequential laparoscopic cholecystectomy	Very effective	Less invasive	Unnecessary ERCP, Endoscopic complications	Most hospitals
Laparoscopic cholecystectomy and sequential endoscopic bile duct clearance	Effective	Less invasive	Endoscopic complications, Further procedures	Most hospitals

ERCP: Endoscopic retrograde cholangiography.