Two leading treatments for choledocholithiasis—laparoscopic bile duct exploration (lbeps) and ERCP with laparoscopic cholecystectomy—show similar effectiveness, but surgeons can leverage their distinct recovery profiles.

• Both methods achieved 100% stone clearance with no conversions to open surgery, but lbeps showed quicker postoperative recovery of liver function tests.
• Patients receiving lbeps faced less acute cholangitis and had lower baseline liver enzyme levels, indicating a potential advantage for older patients with specific profiles.

Surgeons should tailor treatment selection based on individual patient circumstances to optimize outcomes.

• Complication rates were comparable, with lbeps complications mainly being bile leakage and infection, while ERCP had higher acute pancreatitis rates.