Combined ERCP and Laparoscopic Cholecystectomy for Treatment of Choledecolithiasis, why should we start with ERCP?

Background: ERCP (endoscopic retrograde cholangiopancreatography) stone extraction followed by laparoscopic cholecystectomy (LC) –during the same hospital stay or another admission- is now the standard way of management of concomitant cholelithiasis and choledocholithiasis. Based on recent literature we adopted combined (single session) ERCP and LC as the standard treatment strategy for such cases.Methods: Sixty-six patients were enrolled in our study and were divided randomly in two equal groups. All patients had combined ERCP and LC. In group A we started with ERCP, while in group B we started with LC. Both groups were compared regarding the time consumed during the operation, outcome, complications, and the final outcome.Results: There was marked increase in the procedure time in group A (83.79 ± 18.87) minutes compared to (78.24 ± 23.79) in group B. Both groups showed comparable results regarding the hospital stay (1.21 ± 0.70) in both groups, no cases with post-operative bile leak or haemorrhage were reported in either group, post-ERCP pancreatitis occurred in one patient (3%) in each group, and surgical site infection (SSI) was also observed in one patient (3%) per group. Conclusion: Although performing LC first may offer intraoperative technical advantages, especially by avoiding intestinal distension, we recommend initiating the single-session approach with ERCP. In expert hands, the challenges associated with ERCP-first are manageable and provide offer significant clinical benefits.