Timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography and its impact on clinical outcomes: A synthesis without meta‐analysis

Background The optimal timing of laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography for choledocholithiasis remains controversial. Delayed cholecystectomy has been associated with recurrent biliary events and increased surgical complexity. This study aimed to evaluate the impact of the timing of LC following endoscopic retrograde cholangiopancreatography for choledocholithiasis on clinical outcomes. Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Studies evaluating outcomes of LC performed after endoscopic retrograde cholangiopancreatography were included. Outcomes assessed included conversion to open surgery, endoscopic retrograde cholangiopancreatography (ERCP) success, peri‐operative and post‐operative complications, length of hospital stay (LOS), operating time (OT), need for repeat ERCP, abdominal drain use, cost outcomes and mortality. Results A total of 47 studies, comprising 110 patient groups and 7009 patients, were included. Early LC (≤24 h) was associated with the lowest conversion rates and the highest ERCP success, whereas delayed LC was associated with progressively higher conversion rates, primarily driven by adhesions and unclear anatomy. Overall complication rates were lowest in the early and intermediate timing groups (≤24 h: 2.27%; 2–3 days: 2.46%) and highest among patients undergoing LC more than 30 days after ERCP (5.96%). Mean LOS increased with increasing delays (7.9 days in ≤24 h vs. 10.9 days in >30 days), while operating time showed no consistent linear trend across timing groups. ERCP‐related complications and mortality were rare across all groups. Conclusion Early LC following ERCP preferably within 24 h and no later than 3 days is associated with lower conversion rates, fewer overall complications, shorter hospital stay and favourable procedural outcomes. Delaying LC beyond 30 days is associated with increased cumulative morbidity without demonstrable clinical benefit. When feasible, early or same‐admission cholecystectomy should be considered the preferred management strategy.