Abstract
Abstract
Background
Laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) is standard for gallstones with common bile duct stones, but the optimal ERCP-to-LC interval remains uncertain. This study assessed the association between the interval and intraoperative adhesion severity and operative difficulty
Objective
To compare early (≤ 72 hours) and late (> 72 hours) LC after ERCP with respect to intraoperative adhesion severity among patients treated at MCM Comprehensive Specialized Hospital, Addis Ababa.
Methods
A facility-based retrospective comparative cross-sectional study included 102 adults who underwent LC after ERCP for choledocholithiasis between January 2023 and March 2026. All eligible patients during the study period were included. Data were abstracted from medical records, ERCP reports, imaging, and operative notes and analyzed using SPSS v27. Adhesions were graded using the Zühlke classification, with grades II–IV considered severe. Binary and multivariable logistic regression were performed, reporting crude and adjusted odds ratios (AORs) with 95% CI. Robustness was assessed using a ≤ 6-month interval and a log-transformed continuous ERCP–LC interval.
Results
Early LC was performed in 47 patients (46.1%) and late LC in 55 (53.9%), with a median ERCP–LC interval of 4 days. Severe adhesions were present in 59 patients (57.8%) and were more frequent following late LC than early LC (63.6% vs 51.1%; OR 1.68, 95% CI 0.76–3.71; p = 0.200). On bivariate analysis, hydropic gallbladder was the only factor significantly associated with severe adhesions (OR 4.80; p = 0.024). After adjustment for potential confounders, late LC was associated with higher odds of severe adhesions, although the association didn’t reach statistical significance (AOR 2.39, 95% CI 0.95–6.01; p = 0.064). In a sensitivity analysis excluding outlier, the association reached statistical significance (AOR 2.57; p = 0.047). Furthermore, among patients undergoing LC within 6 months of ERCP, each log-unit increase in the ERCP–LC interval was associated with a 69% increase in the odds of severe adhesions (AOR 1.69, 95% CI 1.16–2.48; p = 0.007).
Conclusion
A longer ERCP-to-LC interval was associated with denser intra-operative adhesions, The findings favor operating early after ERCP where circumstances allow, although the 72-hour mark is better read as a practical guide than as a fixed threshold.