One-stage vs two-stage treatment in acute cholecystitis: Comparable morbidity, superior efficiency

INTRODUCTION: Optimal management of patients presenting with acute cholecystitis and suspected choled-ocholithiasis remains debated, with both one-stage (laparoscopic cholecystectomy with intraoperative cholangiography ± CBD exploration) and two-stage (preoperative ERCP followed by delayed laparoscopic cholecystectomy) strategies widely employed. The objective is to compare clinical outcomes, postoperative morbidity, and length of stay between one-stage and two-stage approaches in patients with acute cholecystitis and radiologic or biochemical suspicion of CBD stones
METHODS: This retrospective cohort study included 247 consecutive patients treated at a tertiary HPB referral center between 2020–2025. Primary outcomes were total length of hospital stay and 30-day morbidity. Secondary outcomes included residual stones, reintervention, readmission, and predictors of postoperative complications. Multivariable logistic regression, Kaplan–Meier analyses, and ROC modeling were performed.
RESULTS: Of 247 patients, 118 (47.8%) underwent a one-stage strategy and 129 (52.2%) received the two-stage approach. Length of stay was significantly shorter in the one-stage group (8.6±4.4 vs 11.2±4.4 days, p<0.001). Overall, 30-day morbidity was comparable between strategies (19.5% vs. 19.4%, p=1.000). Logistic regression revealed no independent predictors of morbidity. ROC analysis demonstrated poor diagnostic performance for bilirubin and CBD diameter in predicting CBD stones (AUC=0.53).
DISCUSSION AND CONCLUSION: In appropriately selected patients with acute cholecystitis and suspected choledocholithiasis, the one-stage strategy is safe and provides significantly shorter hospitalization while maintaining similar morbidity rates compared with the conventional two-stage approach.

Keywords: Acute cholecystitis, choledocholithiasis, ERCP, laparoscopic CBD exploration, one-stage strategy, postoperative morbidity