Early versus delayed laparoscopic cholecystectomy following endoscopic retrograde cholangiopancreatography for concomitant gallstones and common bile duct stones: a retrospective study

BACKGROUND: The optimal timing for laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) in patients with both gallbladder and common bile duct stones remains debated. This study aimed to evaluate clinical outcomes based on the timing interval of sequential LC performed within two weeks post-ERCP. METHODS: We conducted a retrospective analysis of 241 patients with concomitant cholecystolithiasis and choledocholithiasis who underwent ERCP followed by LC at our institution between January 2018 and December 2023. Patients were stratified into three cohorts based on the ERCP-to-LC interval: Group A (≤ 24 h, n = 78), Group B (24-72 h, n = 83), and Group C (72 h-2 weeks, n = 80). Comparative analyses were performed regarding baseline demographics, perioperative laboratory and imaging data, surgical findings, and postoperative recovery. Logistic regression was employed to determine risk factors associated with delayed surgery (72 h-2 weeks). RESULTS: Compared to Groups A and B, Group C exhibited a significantly prolonged total hospital stay (P < 0.001) and increased overall medical expenses (P < 0.001). Furthermore, Group C demonstrated higher incidences of post-ERCP acute cholecystitis (P = 0.005) and total postoperative adverse events (P = 0.042). Multivariate analysis identified preoperative total bilirubin exceeding three times the upper limit of normal, post-ERCP pancreatitis, and post-ERCP bleeding as independent predictors for delayed LC. CONCLUSION: In the absence of serious complications or high-risk factors, performing LC within 72 h after ERCP is recommended to reduce hospital stay, lower healthcare costs, and minimize complication rates. However, for patients presenting with severe preoperative hyperbilirubinemia or post-ERCP adverse events, a delayed surgical approach following comprehensive individual assessment is recommended.