236 Meta-Analysis of the Optimal Timing of Laparoscopic Cholecystectomy Following Endoscopic Retrograde Cholangiopancreatography (ERCP) for CBD Clearance

Abstract Aim The optimal timing of laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct (CBD) stone removal remains debated. This meta-analysis compares early (≤72 hours) versus late (>72 hours) LC post-ERCP to assess surgical outcomes and patient safety. Method A systematic search was conducted across PubMed, Embase, Scopus, and the Cochrane Library for studies published between January 2000 and March 2025. Eligible studies included randomized controlled trials and observational studies that compared early versus late LC following successful CBD clearance by ERCP. Primary outcomes included conversion to open surgery and operative time. Secondary outcomes were length of hospital stay, overall morbidity, and bile duct injury. Data were analysed using a random-effects model with Cochrane RevMan, and results were visualised through forest plots. Results Twenty-one studies with a combined total of 2827 patients (1511 early LC, 1316 late LC) were included. Early LC significantly reduced the conversion rate to open surgery (OR: 0.41, 95% CI: 0.25–0.66, p = 0.0002), operative time (SMD: -1.28, 95% CI: -1.74 to -0.81, p < 0.00001), and overall complications (OR: 0.34, 95% CI: 0.18–0.65, p = 0.0009). No statistically significant differences were observed in hospital stay (SMD: -0.20, p = 0.64) or bile duct injury (OR: 0.39, p = 0.07). Conclusions Early LC within 72 hours after ERCP is associated with improved surgical outcomes and fewer complications. These findings support early LC as the preferred timing in suitable patients, although further high-quality randomised trials are needed.