Mahmood WU, Lubbad O, Hamed O, Shafique S, Khera G, Singh KK, Sajid MS. Single-step laparoscopic surgery reduces postoperative morbidity in the management of gallstones. World J Meta-Anal 2026; 14(3): 121913 [DOI: 10.13105/wjma.121913]
Corresponding Author of This Article
Wajeeh Ullah Mahmood, MD, Medical School, Brighton and Sussex Medical School, 94 N - S Rd, Brighton BN19PX, Brighton and Hove, United Kingdom. w.mahmood1@uni.bsms.ac.uk
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Surgery
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Mahmood WU, Lubbad O, Hamed O, Shafique S, Khera G, Singh KK, Sajid MS. Single-step laparoscopic surgery reduces postoperative morbidity in the management of gallstones. World J Meta-Anal 2026; 14(3): 121913 [DOI: 10.13105/wjma.121913]
World J Meta-Anal. Sep 18, 2026; 14(3): 121913 Published online Sep 18, 2026. doi: 10.13105/wjma.121913
Single-step laparoscopic surgery reduces postoperative morbidity in the management of gallstones
Wajeeh Ullah Mahmood, Omar Lubbad, Omar Hamed, Shehram Shafique, Goldie Khera, Krishna K Singh, Muhammad Shafique Sajid
Wajeeh Ullah Mahmood, Omar Lubbad, Omar Hamed, Medical School, Brighton and Sussex Medical School, Brighton BN19PX, Brighton and Hove, United Kingdom
Shehram Shafique, Department of Surgery, Worthing Hospital, Worthing BN112DH, West Sussex, United Kingdom
Goldie Khera, Krishna K Singh, Muhammad Shafique Sajid, Department of Gastrointestinal Surgery, Royal Sussex County Hospital, Brighton BN25BE, Brighton and Hove, United Kingdom
Author contributions: Mahmood WU, Lubbad O, and Hamed O designed the study and collected data; Mahmood WU contributed to writing of the manuscript; Sajid MS contributed to study design and revision; Shafique S, Singh KK and Khera G contributed to quality and professional revision. All authors have read and approved the final manuscript.
AI contribution statement: Portions of this manuscript were edited using AI tools for language refinement. The authors agree to accountability for all content of this manuscript, including any portions for which AI tools were used as assistive technology. The authors confirm that all AI-assisted outputs have been carefully reviewed, verified, and validated. The authors take full responsibility for the accuracy, integrity, and originality of the manuscript. AI tools were not used to generate data, perform analyses, or draw scientific conclusions.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2020 Checklist, and the manuscript was prepared and revised according to the PRISMA 2020 Checklist.
Corresponding author: Wajeeh Ullah Mahmood, MD, Medical School, Brighton and Sussex Medical School, 94 N - S Rd, Brighton BN19PX, Brighton and Hove, United Kingdom. w.mahmood1@uni.bsms.ac.uk
Received: April 7, 2026 Revised: May 17, 2026 Accepted: June 10, 2026 Published online: September 18, 2026 Processing time: 160 Days and 12.4 Hours
Abstract
BACKGROUND
Cholecystocholedocholithiasis is conventionally managed by two-step endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy, but single-stage laparoscopic-endoscopic rendezvous (LERV) has emerged as a promising alternative.
AIM
To compare the outcomes of patients with cholecystocholedocholithiasis undergoing either single-step laparoscopic rendezvous (LERV) vs traditional two-step ERCP and laparoscopic cholecystectomy.
METHODS
Standard medical databases such as MEDLINE, EMBASE, PubMed, and Cochrane Library were searched to identify randomized controlled trials comparing outcomes of patients with cholecystocholedocholithiasis who were surgically managed with either LERV or ERCP and laparoscopic cholecystectomy. All data were analyzed using Review Manager Software 5.4, and meta-analysis was performed with a random-effect model analysis.
RESULTS
A total of six randomized, controlled trials were included comprising 952 patients (LERV: n = 480; two-step ERCP + laparoscopic cholecystectomy: n = 472). Random effect model analysis revealed that overall morbidity was reduced in patients undergoing LERV [odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.26-0.73, Z = 3.19, P = 0.001]. There were fewer postoperative pancreatitis cases when LERV was used; however, this was not statistically significant (OR = 0.37, 95%CI: 0.06-2.39, Z = 1.04, P = 0.30). There was no statistical difference in successful common bile duct stone clearance between the two procedures (OR = 1.67, 95%CI: 0.61-4.58, Z = 1.00, P = 0.32). Surgical intervention reduced length of stay (Standardized mean difference: -1.05, 95%CI: -1.65 to -0.44, Z = 3.40, P = 0.0007), but with high heterogeneity (I2 = 93%).
CONCLUSION
LERV was associated with a reduced length of hospital stay and morbidity compared with two-step ERCP and laparoscopic cholecystectomy.
Core Tip: Cholecystocholedocholithiasis is conventionally managed by two-step endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy. Laparoscopic-endoscopic rendezvous (LERV) offers a single-stage alternative. This meta-analysis of six randomized controlled trials (952 patients) demonstrates that LERV significantly reduces hospital stay and overall morbidity compared with the two-step strategy without compromising common bile duct stone clearance or increasing post-procedure pancreatitis. These findings support wider adoption of LERV in centers with appropriate expertise.
