Timing of Laparoscopic Cholecystectomy Post-ERCP: Impact on Surgical and Postoperative Outcome

Abstract

The standard management of Common Bile Duct (CBD) stones involves Endoscopic Retrograde Cholangiopancreatography (ERCP) for stone clearance, followed by Laparoscopic Cholecystectomy (LC). However, the optimal timing of LC after ERCP remains debated, as inappropriate intervals can increase postoperative complications, such as inflammation, adhesions, and injury to adjacent structures, including the duodenum or biliary tract. This study aims to compare the technical difficulties and outcomes of early versus delayed LC following ERCP to determine the most suitable timing for surgery. This cross-sectional study was conducted at Government Rajaji Hospital, Madurai, from April 2024 to April 2025. A total of 80 patients who underwent LC after ERCP in the Department of General Surgery were included. Among them, 45 patients underwent LC within 3 days of ERCP (early group), and 35 patients underwent LC after 3 days (delayed group). Several intraoperative and postoperative factors were assessed and compared, including gallbladder adhesions, frozen Calot’s triangle, drain placement, operative time, conversion to open surgery, and duration of postoperative hospital stay. The majority of patients were aged between 41 and 60 years. The delayed group showed a significantly higher incidence of dense adhesions, frozen Calot’s triangle, requirement for drain placement, longer operative time, higher conversion rates to open surgery, and prolonged hospital stay compared to the early group. Based on these findings, performing laparoscopic cholecystectomy within 3 days of ERCP is associated with fewer technical challenges, reduced operative time, lower conversion rates, and shorter hospital stays. Delaying surgery beyond this period increases operative difficulty and postoperative morbidity. Therefore, the ideal timing for LC after ERCP is within 72 h to achieve optimal surgical outcomes and minimise complications.