Index laparoscopic cholecystectomy following clearance of common bile duct stone via endoscopic retrograde cholangiography

Abstract Background The optimal timing for laparoscopic cholecystectomy (LC) following endoscopic common bile duct stone extraction remains controversial, with no definitive evidence establishing the best time for surgery. Timing ranges from early (within 72 h) to late (beyond 7 days or extending up to 4–6 weeks), but the outcomes of these timings are still debated. There is substantial concern regarding the recurrence of biliary events while waiting for surgery. Aim This study aims to evaluate the safety and feasibility of index laparoscopic cholecystectomy (performed during the same admission) after the successful clearance of common bile duct stones. Methods Fifty patients were randomly assigned to either the index or delayed group. In the index group, LC is performed on the next day after successful endoscopic clearance of stones from the common bile duct during the index (same) admission, whereas it is performed after 6 weeks for the delayed group. Results The incidence of recurrence of biliary events is 28% in the delayed group, which is significantly higher than in the index LC group ( p = 0.004 ). The delayed group carries a higher risk of morbidity (risk ratio 2, risk difference 0.28, 95% confidence interval 0.98 to 4.1, p = 0.04). The overall hospital stays are significantly shorter in the index group than in the delayed group (mean 3.28 ± 1.7 vs 5 ± 2.1 days, respectively). There is also no difference between the two groups in conversion to open. Conclusion Index laparoscopic cholecystectomy is a feasible procedure that can be performed safely, resulting in reduced overall morbidity, shorter hospital stays, and improved outcomes concerning intraoperative difficulty. Furthermore, it may help prevent future episodes of biliary events.