Comparison of Early Versus Interval Laparoscopic Cholecystectomy After ERCP Stenting in Patients with Choledocholithiasis: A Prospective Comparative Study

Abstract

Introduction: Choledocholithiasis is a common complication where gallstones move from the gallbladder into the common bile duct or form directly in the duct, causing obstruction to bile flow and may lead to biliary obstruction, cholangitis, and pancreatitis. Endoscopic Retrograde Cholangiopancreatography (ERCP) is used for clearance of common bile duct stones, followed by laparoscopic cholecystectomy (LC) to prevent recurrence. The optimal timing of LC after ERCP remains unclear.

Methods: The aim of this study is to compare the perioperative outcomes of early versus interval laparoscopic cholecystectomy after ERCP in patients diagnosed with choledocholithiasis. This prospective comparative study was conducted in a tertiary care hospital over 12 months from 2024 to 2025. A total of 162 patients were included and divided into two groups: early LC performed within 72 hours of ERCP and interval LC performed after 6 weeks. Data were collected using a structured proforma and master chart. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, New York, USA). Continuous variables were expressed as mean and standard deviation. Multivariate analysis was performed using logistic regression. Correlation between variables was assessed using Chi square test and Fisher’s exact test. A p value less than 0.05 was considered statistically significant.

Results: A total of 162 patients were included. The mean operative time was shorter in the early LC group (65.4 ± 10.2 minutes) compared to the interval LC group (70.1 ± 11.5 minutes) (p = 0.01). Hospital stay was shorter in the early group (3.2 ± 0.8 days) compared to the interval group (4.5 ± 1.1 days) (p < 0.001). Return to normal activities was earlier in the early group (7.5 ± 2.1 days) compared to the interval group (9.8 ± 2.5 days) (p < 0.001). Dense adhesions were more common in the interval group (22.2%) compared to the early group (14.8%). Conversion to open surgery and postoperative complications were higher in the interval group but were not statistically significant. On multivariate analysis, interval LC was identified as an independent predictor of postoperative complications (p = 0.03).

Conclusion: Early laparoscopic cholecystectomy after ERCP is associated with shorter operative time, reduced hospitalisation duration, and faster recovery. Interval cholecystectomy is associated with increased adhesions and higher risk of complications. Early LC should be preferred in patients with choledocholithiasis.