A Comparative Study between Early Vs Late Laparoscopic Cholecystectomy in Patients with Choledocholithiasis after ERCP

Introduction: Choledocholithiasis, the presence of stones in the common bile duct, can be primary or secondary, with secondary being more common. Diagnosis typically involves symptoms and imaging, with ERCP serving as both diagnostic and therapeutic. Laparoscopic cholecystectomy is the gold standard treatment, and studies indicate better outcomes when performed within 72 hours post-ERCP. This study aims to evaluate optimal timing for laparoscopic cholecystectomy after ERCP and assess associated morbidity. Methodology: This prospective randomized study at JLN Medical College between December 2022 to July 2024 evaluated 50 patients with concomitant gallbladder and CBD stones, divided into early (within 3 days) and late (4 weeks after ERCP) laparoscopic cholecystectomy groups. Data collected included demographics, preoperative findings, and intraoperative outcomes to assess surgical efficacy and complications and also post-operative morbidity and hospital stay. Results: The study includes 50 patients with concomitant gallbladder and CBD stones , which are randomly arranged in two groups i.e. early and late laparoscopic cholecystectomy after ERCP with mean age of patients was 48.10 years, predominantly female (72%). Abdominal pain was reported in 90% of cases. Early cholecystectomy resulted in significantly shorter operation times (37.6 vs. 54.2 minutes) and reduced hospital stays (29.92 vs. 62.48 hours). Additionally, this group had fewer intraoperative complications, highlighting the benefits of early intervention. Conclusion: The study recommends early cholecystectomy for patients with cholelithiasis and choledocholithiasis post-ERCP, citing benefits like shorter procedure times, fewer complications, less postoperative pain, and reduced hospital stays. These findings support timely intervention, though further research with larger sample sizes is needed for definitive guidelines on surgical timing.