Background Cholecystocholedocholithiasis (CCL) presents significant management challenges. The optimal sequencing of laparoscopic cholecystectomy (LC) and endoscopic retrograde cholangiopancreatography (ERCP) when performed during the same operative session remains controversial. This study compared the efficacy, safety, and clinical outcomes of two same-session approaches: LC-first versus ERCP-first. Patients and methods A retrospective comparative study was conducted at Yemen Germany Hospital, Sana’a, Yemen, between January 2017 and August 2022. A total of 150 patients were included. Group A (n = 80) underwent ERCP-first followed by LC, while Group B (n = 70) underwent LC-first followed by intraoperative ERCP. All procedures were performed by a surgeon-led team with expertise in advanced laparoscopy and therapeutic ERCP. Primary outcomes included successful common bile duct (CBD) stone clearance, operative time, and conversion to open surgery. Secondary outcomes included technical difficulty, complications, hospital stay, and cost. Statistical significance was set at p < 0. 05. Results Successful CBD stone clearance was achieved in 70 patients (87. 5%; 95% CI: 78. 5%-93. 3%) in Group A and 67 patients (95. 7%; 95% CI: 88. 1%-98. 9%) in Group B (p = 0. 098). Mean total operative time was significantly shorter in Group B (69. 8 ± 22. 1 minutes) compared with Group A (83. 3 ± 13. 5 minutes; p < 0. 001). The mean LC duration was also shorter in Group B (38. 4 ± 13. 2 vs. 41. 2 ± 8. 98 minutes; p = 0. 046), while ERCP duration did not differ significantly (37. 4 ± 11. 4 vs. 43. 3 ± 11. 8 minutes; p = 0. 122). Median hospital stay and estimated cost were also lower in Group B (1 vs. 3 days and 1, 100 vs. 1, 300; p < 0. 001 and p = 0. 04, respectively). Conversion to open surgery occurred in seven patients (8. 8%; 95% CI: 3. 6%-17. 2%) in Group A and two patients (2. 9%; 95% CI: 0. 3%-9. 9%) in Group B (p = 0. 17). Technical difficulty due to bowel distension was observed only in Group A (four patients; 5. 0%; 95% CI: 1. 4%-12. 3%; p = 0. 12). Postoperative pancreatitis occurred in four patients (5. 0%; 95% CI: 1. 4%-12. 3%) in Group A and two patients (2. 9%; 95% CI: 0. 3%-9. 9%) in Group B (p = 0. 68). Conclusions Both sequencing strategies were safe and effective when performed by an experienced, surgeon-led team. The LC-first approach was associated with shorter operative time, specifically due to a shorter LC duration, reduced hospital stay, and lower cost, while maintaining comparable stone clearance rates. These findings suggest that, in settings with coordinated surgical-endoscopic expertise, the LC-first approach may be preferable. Prospective randomized studies are needed to confirm these findings and evaluate patient-reported outcomes.
Ateik et al. (Sat,) studied this question.