Introduction: Advances in interventional endoscopy and laparoscopic surgery have significantly changed the treatment of gallbladder lithiasis associated with common bile duct stones, allowing them to be treated in a single anaesthetic procedure by laparoscopic cholecystectomy and endoscopic sphincterotomy. The aim of this study was to clarify the performance of this technique and its indications and, secondarily, to study the risk factors for complications and failure of this procedure, based on the experience of the Department of Visceral Surgery and Gastroenterology.

Patients and Method: This is an observational, retrospective, descriptive and analytical study. Data were collected from the medical records of 161 patients with common bile duct stones concomitant with gallbladder stones treated at the Cheikh Zaid International University Hospital in Rabat between 2016 and 2022. A follow-up survey was conducted by telephone in 2023 to assess the satisfaction and medium- and long-term outcomes of all patients. A total of 144 patients who had undergone cholecystectomy and endoscopic sphincterotomy in a single anaesthetic procedure were included in the study. This single-stage procedure was evaluated by looking at clinical, biological, radiological, peri- and post-operative data, the cost of the hospital stay, and data from the telephone survey. Risk factors for complications and failure of this procedure were also investigated using univariate and multivariate statistical analysis.

Results: In this study, females accounted for 54.2% of the sample, with a male/female sex ratio of 0.85. The mean age was 59.2 ± 18.7 years, with extremes of 16 and 98 years. The predominant age group was between 60 and 80 years, accounting for 39.6%. In terms of surgical data, the most common technical difficulty during cholecystectomy was pediculitis in 33.3% of cases, and choledochal stone formation during sphincterotomy in 32% of cases. Total cholecystectomy was performed in 95.8% of cases. The single-stage anaesthetic procedure had a high success rate of 95%. It involved a hospital and post-operative stay of 1 to 2 days, morbidity and mortality rates of 7.6% and 0% respectively, and hospital costs of 27,606 Moroccan dirhams. The risk factors for complications and failure of this procedure were the presence of a thin VBP, which was associated with 23.5% complications and 11.8% failure (p=0.065), or a diverticular papilla, which was associated with 33.3% failure.

Conclusion: The combined approach of laparoscopic cholecystectomy and endoscopic sphincterotomy under a single anaesthetic is safe and 95% effective. It reduces morbidity and mortality, length of hospital stay, number of general anaesthetics and hospital costs, with a view to early rehabilitation and healthcare savings. It is still important to identify the predictive factors for surgical difficulties in order to better select and advise patients who are eligible for this technique.