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Updated: Jul 16, 2025
Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
Cholecystectomy following endoscopic clearance of common bile duct during the same admission
Eric Bergeron1, Théo Doyon2, Thibaut Manière2
1Department of Surgery, Hôpital Charles LeMoyne, Greenfield Park, Que. (Bergeron); Department of Gastroenterology, Hôpital Charles LeMoyne, Greenfield Park, Que. (Doyon, Maniere, Desilets) eric.bergeron.med@ssss.gouv.qc.ca.
Insights
Performing cholecystectomy during the same hospital admission after common bile duct stone clearance via ERCP is safe. This approach prevents recurrent biliary events, especially in elderly patients with comorbidities, compared to delayed surgery.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
- Clinical Outcomes Research
Background:
- Recurrence of common bile duct stones and biliary events is common after ERCP.
- Early cholecystectomy is recommended but inconsistently performed during the same admission.
Purpose of the Study:
- To compare the safety and efficacy of early versus delayed cholecystectomy after ERCP for common bile duct stone clearance.
- To assess the impact on recurrent biliary events and patient outcomes.
Main Methods:
- Retrospective review of 268 patients undergoing ERCP for gallstone disease and subsequent cholecystectomy (July 2012-June 2022).
- Patients were divided into same-admission (index) and delayed cholecystectomy groups.
- Analysis of demographics, comorbidities (ASA score), operative outcomes, and recurrence rates.
Main Results:
- 71 patients (26.6%) had same-admission cholecystectomy. Older patients (≥80 years) and those with higher ASA scores were more frequent in the index group.
- No significant differences in surgical complications, open cholecystectomy, or mortality between groups.
- Delayed cholecystectomy was associated with longer operative times and significant rates of recurrent common bile duct stones (18.3%) and gallstone events (38.6%) prior to surgery. No recurrences were observed in the index group.
Conclusions:
- Same-admission cholecystectomy after ERCP is safe and feasible, even for elderly patients with comorbidities.
- Early cholecystectomy effectively prevents recurrent biliary events compared to delayed procedures.
- This strategy offers a safe and potentially more effective approach to managing common bile duct stones post-ERCP.
Background:
The recurrence of common bile duct stones and other biliary events after endoscopic retrograde cholangiopancreatography (ERCP) is frequent. Despite recommendations for early cholecystectomy, intervention during the same admission is carried out inconsistently.
Methods:
We reviewed the records of patients who underwent ERCP for gallstone disease and common bile duct clearance followed by cholecystectomy between July 2012 and June 2022. Patients were divided into 2 groups: the index group underwent cholecystectomy during the same admission and the delayed group was discharged and had their cholecystectomy postponed. Data on demographics and prognosis factors were collected and analyzed.
Results:
The study population was composed of 268 patients, with 71 (26.6%) having undergone cholecystectomy during the same admission after common bile duct clearance with ERCP. A greater proportion of patients aged 80 years and older were in the index group than in the delayed group. The American Society of Anesthesiologists score was significantly higher in the index group. There was no significant difference between groups regarding surgical complications, open cholecystectomy and death. The operative time was significantly longer in the delayed group. Among patients with delayed cholecystectomy, 18.3% had at least 1 recurrence of common bile duct stones (CBDS) and 38.6% had recurrence of any gallstone-related events before cholecystectomy. None of these events occurred in the the index group. There was no difference in the recurrence of CBDS and other biliary events after initial diagnosis associated with stone disease.
Conclusion:
Cholecystectomy during the same admission after common bile duct clearance is safe, even in older adults with comorbidities. Compared with delayed cholecystectomy, it was not associated with adverse outcomes and may have prevented recurrence of biliary events.
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