Purpose: Current management of patients with choledocholithiasis involves two stages consisting of ERCP and laparoscopic cholecystectomy (LC). Following the advent of techniques of laparoscopic ductal stone clearance, an alternative single-stage laparoscopic treatment was introduced for these patients. Various randomized controlled trials (RCTs) done in past to compare these 2 modalities but with different and controversial results. Therefore, we conducted meta-analysis to compare the two-stage versus single-stage process for management of choledocholithiasis. Methods: MEDLINE, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, PubMed, and recent abstracts from major conference proceedings were searched (5/2010). RCTs comparing ERCP and LC versus single-stage laparoscopically-assisted CBD stone extraction were included. Standard forms were used to extract data by two independent reviewers. The effects of both the methods were analyzed by calculating pooled estimates for stone extraction efficacy, complications, and cross-over to other techniques. Separate analyses were performed for each outcome by using odds ratio (OR) or weighted mean difference (WMD) by fixed and random effects models. Publication bias was assessed by funnel plots. All were graded by Jadad score. Heterogeneity among studies was assessed by calculating I2 measure of inconsistency. Results: Five trials met inclusion criteria (N=607). Trials were of adequate quality (Jadad score ≥2). Three trials used ERCP pre-cholecystectomy whereas two other trials used ERCP post-cholecystectomy. No significant heterogeneity was noted for any of the outcomes. CBD stone extraction was noted in 89.0% with the two-stage process whereas 84.6% in the single-stage laparoscopy-assisted CBD stone removal. Trend of higher stone extraction was noted in the two-stage ERCP and laparoscopic cholecystectomy group but did not reach a significant level (OR 1.39; 95% CI: 0.81-2.38, p=0.23). Similarly, a low incidence of lower complications and less cross-over to other techniques for stone removal were noted in ERCP group, but again, did not reach a significant level. (OR 0.77; 95% CI: 0.49-1.25, p=0.26; OR 0.81; 95% CI: 0.49-1.35, p=0.45), respectively. Funnel plot revealed no publication bias. Conclusion: The two stage process consisting of ERCP-assisted CBD stone extraction with LC resulted in similar outcomes to the single stage laparoscopically-assisted CBD stone. However there was trend towards a higher stone extraction and less complication rates with the two stage process. Future multicenter studies with higher number of subjects are required before making a final conclusion.