Comparison of intraoperative versus preoperative ERCP with laparoscopic cholecystectomy for cholecystocholedocholithiasis: a 3-year study at Kepler University Hospital

Preoperative ERCP followed by cholecystectomy is a common treatment for cholecystocholedocholithiasis. However, intraoperative ERCP has been used more frequently over the last two decades, with few studies assessing various aspects of both methods. We evaluated and compared the management and outcomes of intraoperative ERCP and preoperative ERCP.

This is a retrospective cohort study of a prospective registry. A total of 169 patients with cholecystocholedocholithiasis underwent either intraoperative ERCP or preoperative ERCP followed by cholecystectomy. Between January 2020 and June 2023 patients were further analysed for morbidity, surgical technique, ERCP and surgical indications, length of stay and success rate of ERCP.

103 patients (60.9%) underwent intraoperative ERCP and 66 patients (39.1%) an ERCP later followed by cholecystectomy. Patients with intraoperative ERCP tended to have a lower rate of post-ERCP pancreatitis (3.9% vs. 6.1%; P = 0.537), fewer ERCP complications (3.9% vs. 10.6%; P = 0.116), a reduced hospital stay (8 vs. 13.8 days; P < 0.001) and a lower cannulation failure rate of the common bile duct during ERCP (1.9% vs. 6.1%; P = 0.088).

Our study identified several advantages of intraoperative simultaneous ERCP over upfront ERCP, suggesting that intraoperative ERCP may be a viable and safe option for the comprehensive management of cholecystocholedocholithiasis.