MODERN STRATEGIES FOR THE TREATMENT OF CHOLEDOCHOLITHIASIS: ANALYSIS OF INTERNATIONAL GUIDELINES AND CLINICAL STUDIES (Literature Review)

Choledocholithiasis remains a significant clinical challenge in modern hepatobiliary surgery, affecting approximately 10–20% of patients with symptomatic gallstone disease. Over the past decades, treatment strategies have evolved from open surgical exploration of the common bile duct to minimally invasive laparoscopic and endoscopic techniques. This literature review analyzes contemporary international guidelines (ASGE, ESGE, BSG) and major multicenter clinical studies and meta-analyses addressing the management of common bile duct stones. Current evidence indicates that both single-stage (laparoscopic cholecystectomy combined with intraoperative ERCP or laparoscopic common bile duct exploration) and two-stage approaches (preoperative or postoperative ERCP followed by laparoscopic cholecystectomy) demonstrate comparable clinical efficacy, complication rates, and mortality outcomes. However, the single-stage strategy is associated with reduced hospital stay and improved cost-effectiveness due to the elimination of repeated anesthesia and shorter overall treatment duration. Despite extensive research, no universal consensus has been established regarding the optimal management algorithm. The choice of treatment should be individualized and based on the patient's clinical status, severity of obstructive jaundice, institutional technical resources, and the experience of the multidisciplinary team. Minimally invasive techniques continue to represent the cornerstone of modern choledocholithiasis management, emphasizing safety, radical stone clearance, and optimization of perioperative outcomes.

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