Single-stage surgical management versus conventional two-stage management for pediatric choledocholithiasis: A systematic review and meta-analysis

Background: The prevalence of pediatric choledocholithiasis is rising, yet the optimal management strategy remains uncertain. Pediatric practice has traditionally favored a two-stage strategy of endoscopic retrograde cholangiopancreatography (ERCP) for ductal clearance followed by interval laparoscopic cholecystectomy. Single-stage management, combining laparoscopic cholecystectomy with either laparoscopic common bile duct exploration (LC-LCBDE) or intraoperative ERCP (LC-ERCP), offers a potential alternative. This meta-analysis aimed to compare the safety and efficacy of single-stage versus two-stage management in children. Methods: A PRISMA-compliant systematic review was registered with PROSPERO (CRD420251169007). PubMed, Embase, and Scopus were searched from inception through October 13, 2025. Primary outcomes were postoperative complication rate and length of hospital stay (LOS). Random-effects meta-analysis was performed. Results: Eight retrospective cohort studies comprising 562 pediatric patients (single-stage: 278, conventional: 284) met inclusion criteria. Compared to conventional two-stage management, LC-LCBDE was associated with significantly fewer complications (OR: 0.21, [95% CI: 0.08, 0.60]), reduced pancreatitis (OR:0.27, [95% CI: 0.09, 0.88]), and a shorter LOS (MD: −1.46 days, [95% CI: −2.35, −0.56]), but a greater need for additional procedures (OR: 5.86, [95% CI: 1.05, 32.7]). LC-ERCP was associated with a significantly shorter anesthesia duration (MD: −25.5 min, [95% CI: −49.0, −2.0]) but otherwise did not differ significantly from conventional management. Readmission rates did not differ between groups. Conclusions: Single-stage management, particularly transcystic LC-LCBDE combined with cholecystectomy, represents a viable alternative associated with fewer complications and shorter length of stay. Treatment decisions should be guided by multidisciplinary evaluation and institutional expertise to ensure safe, definitive stone clearance.