When should a laparoscopic cholecystectomy be performed after ERCP for common bile duct stones combined with gallbladder stones? A meta-analysis of randomized controlled trials

Background Gallstones combined with common bile duct stones are a common disease in biliary surgery. At present, for gallbladder stones with common bile duct stones, the globally recognized standard treatment is a step-by-step treatment of “endoscopy combined with surgery”. First, more urgent and potentially life-threatening bile duct stones are treated, and then gallbladder stones are treated. However, after the common bile duct stones are successfully removed by ERCP, how long should laparoscopic cholecystectomy be performed at intervals? There is a dispute between “early” (defined as within 72 h after ERCP) and “delayed” (defined as 72 h after ERCP). The conclusion is not yet uniform. Objective To systematically analyze the efficacy and safety of early LC and delayed LC in patients with gallstones and common bile duct stones after ERCP, to provide current high-level evidence-based medical evidence for clinical decision-making, to help clinicians optimize the diagnosis and treatment process, to reduce the occurrence of adverse complications caused by treatment. Method PubMed, Embase, Cochrane Library, Web of Science, Scopus, and other databases were searched to collect randomized controlled trials (RCTs) comparing early LC and delayed LC after ERCP from inception to December 2025. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies using the Cochrane ROB evaluation tool. The RevMan 5.4 software was used to analyze the outcomes of each group. Unlike previous meta-analyses, this study only included randomized controlled trials and incorporated the latest ones. Moreover, the quality of each outcome indicator was evaluated using the GRADE method. Result This meta-analysis included 7 randomized controlled trials involving 593 patients (296 in the early LC group and 297 in the delayed LC group). Compared with the delayed LC group, the early LC group was associated with a significantly lower rate of conversion to open surgery ( RR = 0.35, 95 % CI : 0.17–0.68, P = 0.002), shorter operation time ( MD = −14.37 min, 95 % CI : −28.22 to −0.51, P = 0.04), shorter postoperative hospital stay ( MD = −0.81 days, 95 % CI : −1.20 to −0.42, P < 0.0001), and lower incidence of incision infection (RR = 0.21, 95 % CI : 0.07–0.61, P = 0.004). No significant difference was observed between the two groups in the incidence of bile leakage ( RD = −0.04, 95 % CI : −0.12–0.04, P = 0.30). Conclusion In conclusion, the available RCT evidence suggests that early LC following successful ERCP may provide clinical advantages over delayed LC, including lower conversion and infection rates and shorter operative and postoperative hospital stay. However, because of outcome-level heterogeneity, the limited number of included trials, and few bile-leakage events, these findings should be interpreted with caution and further verified in larger well-designed RCTs. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261395564 , PROSPERO CRD420261395564.