الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Summary Box What is already known:
• Endoscopic retrograde cholangiopancreatography (ERCP) has been the gold standard for the diagnosis and management of choledocholithiasis.
• Despite the evidence from prospective randomized trials suggesting the superiority of the so-called one-stage management of cholecystocholedocholithiasis (LERV), two-stage techniques, mainly preoperative ERCP followed by laparoscopic cholecystectomy, are currently being used by most clinicians according to the literatures.
• ERCP is associated with a rate of failure to cannulate the ampulla of Vater ranging from 4-18%.
• Post-ERCP pancreatitis (PEP) is one of the concerns in patients who undergo ERCP.
What the new findings are:
• LERV has higher rate of successful common bile duct (CBD) cannulation compared to ERCP.
• ERCP has a similar rate of CBD clearance compared to LERV
• Patients undergoing LERV have a lower incidence of PEP and hyperamylasemia
The optimal treatment for concomitant gallstones and CBDS is still under debate, and greatly varies among different centers. While ERCP and following LC is currently preferred in most of hospitals worldwide, with the development of laparoscopic equipment and techniques, laparoscopic CDB exploration and LERV have emerged as the favorable choice in the hands of experienced laparoscopic surgeons and endoscopists since it was first reported.
According to the available guidelines, the treatment of choice for patients affected by CBDS should be tailored not only on each single patient but also on the availability of the expertise and facilities in each center. Even though standard LC is performed worldwide and more often outside specialized centers. (Tarantino, Magistri et al. 2017)
Single-session approach (in the form of LAPAROSCOPIC CBD EXPLORATION or intraoperative ERCP) for managing patients with concomitant gallbladder stones and CBD stones is equally effective and safe to the commonly practiced two-session approach but at the same time is associated with shorter hospital stay, fewer procedures and less cost. Consequently, when local resources and expertise are available it should be offered to fit patients. However, there are several factors that can affect the choice of the technique including the patient fitness, the clinical presentation, the timing of CBD stones diagnosis (established preoperative diagnosis or incidental intraoperative diagnosis), the surgical pathology and the local expertise.