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Background <p>Laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) has been associated with increased operative difficulty; however, the optimal timing of LC remains controversial. This study evaluated operative outcomes and surgical difficulty of LC after ERCP in patients with gallstones and concomitant choledocholithiasis, with a particular focus on surgical timing.</p> Methods <p>We retrospectively reviewed patients who underwent LC after ERCP for choledocholithiasis. Difficult cholecystectomy was defined as the need for a bailout procedure, including conversion to open surgery or subtotal cholecystectomy, operative time &gt; 180&#xa0;min, or intraoperative blood loss ≥ 300&#xa0;mL. Patients were classified according to the ERCP–LC interval as early (≤ 14&#xa0;days), middle (15–60&#xa0;days), or late (≥ 61&#xa0;days). Operative outcomes were compared, and logistic regression analysis was performed to identify predictors of difficult cholecystectomy.</p> Results <p>Among 1008 patients who underwent LC, 193 underwent preoperative ERCP. Forty-nine patients (25.4%) met the criteria for difficult cholecystectomy. The incidence was significantly higher in the middle group (33.0%) than in the early (7.7%, P = 0.036) and late groups (15.4%, P = 0.008). Postoperative complication rates did not differ among the groups; however, the late group had a higher incidence of recurrent biliary complications between ERCP and surgery. Multivariate analysis identified age ≥ 60&#xa0;years, male sex, acute cholecystitis, and an ERCP–LC interval of 15–60&#xa0;days as independent risk factors for surgical difficulty. Compared with the early and late groups, the 15–60-day interval was associated with increased odds of difficult cholecystectomy (OR 6.29 and 2.61, respectively).</p> Conclusions <p>An ERCP–LC interval of 15–60&#xa0;days is associated with increased surgical difficulty. Surgeons should consider both surgical timing and interval biliary complications and be prepared to perform bailout procedures when necessary.</p> Graphical Abstract <p></p>

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Preoperative difficulty assessment of laparoscopic cholecystectomy after treatment for choledocholithiasis

  • 期刊论文

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  • 发表日期：

    2026年7月9日

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  • Masahiro Shiihara,
  • Mitsugi Shimoda,
  • Mitsuru Watanabe,
  • Ryoichi Miyamoto,
  • Jiro Shimazaki,
  • Shuji Suzuki

摘要

Background

Laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) has been associated with increased operative difficulty; however, the optimal timing of LC remains controversial. This study evaluated operative outcomes and surgical difficulty of LC after ERCP in patients with gallstones and concomitant choledocholithiasis, with a particular focus on surgical timing.

Methods

We retrospectively reviewed patients who underwent LC after ERCP for choledocholithiasis. Difficult cholecystectomy was defined as the need for a bailout procedure, including conversion to open surgery or subtotal cholecystectomy, operative time > 180 min, or intraoperative blood loss ≥ 300 mL. Patients were classified according to the ERCP–LC interval as early (≤ 14 days), middle (15–60 days), or late (≥ 61 days). Operative outcomes were compared, and logistic regression analysis was performed to identify predictors of difficult cholecystectomy.

Results

Among 1008 patients who underwent LC, 193 underwent preoperative ERCP. Forty-nine patients (25.4%) met the criteria for difficult cholecystectomy. The incidence was significantly higher in the middle group (33.0%) than in the early (7.7%, P = 0.036) and late groups (15.4%, P = 0.008). Postoperative complication rates did not differ among the groups; however, the late group had a higher incidence of recurrent biliary complications between ERCP and surgery. Multivariate analysis identified age ≥ 60 years, male sex, acute cholecystitis, and an ERCP–LC interval of 15–60 days as independent risk factors for surgical difficulty. Compared with the early and late groups, the 15–60-day interval was associated with increased odds of difficult cholecystectomy (OR 6.29 and 2.61, respectively).

Conclusions

An ERCP–LC interval of 15–60 days is associated with increased surgical difficulty. Surgeons should consider both surgical timing and interval biliary complications and be prepared to perform bailout procedures when necessary.

Graphical Abstract