Clinical outcomes of immediate, 24-h, and 24–72-h laparoscopic cholecystectomy after endoscopic stone clearance: a matched cohort analysis

This study aimed to systematically compare the perioperative outcomes of patients undergoing laparoscopic cholecystectomy (LC) at three specific intervals following endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis: immediate (3–6 h), 24-h, and 24–72-h. A propensity score-matched (PSM) cohort analysis was utilized to minimize potential selection bias. A retrospective analysis was conducted on 200 patients treated between January 2021 and December 2025. Patients were categorized into Immediate (3–6 h, n = 45), 24-h (n = 49), and 24–72-h (n = 106) LC groups. To control for confounders, sequential 1:1 nearest-neighbor propensity score matching was performed based on demographics, comorbidities, clinical presentation, stone characteristics, and preoperative laboratory values, yielding 84 well-matched patients (n = 25, 21, and 38 per group, respectively). Perioperative outcomes, postoperative complications, laboratory changes (Δ), and length of stay, were compared among the matched groups. After PSM, baseline characteristics were similar across groups (P > 0.05). The Immediate group had significantly shorter operative time (P = 0.043), Calot’s triangle dissection time (P < 0.001), and less intraoperative blood loss (P = 0.036) versus the 24–72‑h group. On postoperative day 1, the Immediate group showed lower absolute serum amylase (AMY, P = 0.006), alanine aminotransferase (ALT, P = 0.007), and γ‑glutamyl transferase (GGT, P = 0.016). However, change‑from‑baseline (ΔAMY, ΔALT, ΔGGT) did not differ significantly (all P > 0.05), indicating equivalent physiological recovery. The Immediate group had a lower incidence of hyperamylasemia (P = 0.019), while acute pancreatitis rates were similar (P = 0.481). Total hospital stay was shorter in the Immediate group (P = 0.002), but postoperative stay did not differ significantly (P = 0.081). Immediate LC (3–6 h) following ERCP is a safe and efficient strategy. This “extreme-early window” facilitates anatomical dissection before inflammatory changes become restrictive. The significantly reduced total hospital stay stems from clinical process optimization rather than accelerated physiological recovery. Therefore, immediate LC should be recommended as the preferred clinical pathway for eligible patients.