SP 10.15 The 'Subacute' Danger Zone: Impact of ERCP-to-Cholecystectomy Interval on Operative Outcomes
TL;DR
Cholecystectomy within 7 days of ERCP is associated with reduced operative difficulty; longer delays may lessen operative challenge but can expose patients to recurrent biliary events.
Abstract
Up to 30% of patients with gallstone disease develop common bile duct stones. ERCP clears the bile duct but does not prevent recurrent biliary events. Guidelines recommend early laparoscopic cholecystectomy after ERCP, yet delays remain common in UK NHS practice. We assessed how ERCP-to-cholecystectomy interval affects operative difficulty, outcomes, and histopathology. Retrospective cohort of 70 patients undergoing ERCP then laparoscopic cholecystectomy at Wirral University Teaching Hospital (Jan 2023–Sep 2024). Groups: ≤7 days, 8–14 days, 15–42 days, ≥43 days. Primary outcome: operative time. Secondary outcomes: subtotal cholecystectomy, open conversion, complications, readmissions, histopathology. Mean age 62.8 years; median BMI 28.6 kg/m². Median ERCP-to-surgery interval was 79 days. Operative time differed significantly, greatest in the 8–14 day group (median 161 min) versus ≤7 days (66 min) and ≥43 days (77 min) (p=0.021). Six patients required subtotal cholecystectomy; there were no routine open conversions. Chronic cholecystitis predominated on histology. Gallbladder wall thickness did not correlate with operative time, though thick walls were more common in subtotal cases. Cholecystectomy within 7 days of ERCP is associated with reduced operative difficulty. Intermediate delays (8–14 days) increase technical complexity; longer delays may lessen operative challenge but can expose patients to recurrent biliary events.