In recent years, the management of patients requiring both cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) due to choledocholithiasis has evolved significantly. Traditionally, these procedures were performed sequentially, often resulting in prolonged and multiple hospital stays and increased healthcare costs. However, the concept of cholecystectomy combined with intraoperative ERCP (rendezvous approach) is a promising alternative. Despite its potential benefits, sufficient clinical data about the post ERCP-pancreatitis rate and the hospital stay duration are lacking.

A retrospective analysis was conducted at St. John of God Hospital including consecutive patients treated between 2023 and 2024. Complication rates and hospitalisation time were compared between patients undergoing intraoperative ERCP during cholecystectomy and those treated via a sequential ERCP and CHE approach. Statistical comparisons were performed using t- and chi-square test. The method of intervention was not randomized and subject of availability of both surgeons and endoscopists.

A total of 60 patients were included: 42 in the sequential ERCP+CHE group and 18 in the intraoperative ERCP group. 59.5% of those within the sequential ERCP and CHE group, while 72.2% of those within the rendezvous approach group were female. (p=0.52). Mean age was 57.4 (SD 19.5) in the sequential group and 52.4 (SD 21.9) in the combined group (p=0.41). 

Post-ERCP pancreatitis occurred in 11.9% (n=5) of patients in the sequential group and less often in  5.6% (n=1) in the rendezvous approach group  (OR 2,3), however did not reach statistical significance (p=0.69). Notably, 31.0% (n=13) of patients in the sequential group required a repeat ERCP while awaiting cholecystectomy, compared to 1 in the rendevouz group. Patients in the sequential group stayed a mean of 12.4 days (SD 11.9), whereas those undergoing intraoperative ERCP stayed 7.56 days (SD 3.87; p=0.021)

Intraoperative ERCP during laparoscopic cholecystectomy was associated with a shorter hospital stay. In the sequential group, nearly one-third of patients required a repeat ERCP until the cholecystectomy was performed, the OR of post-ERCP pancreatitis was 2.3, but did not differ significantly between the two groups. This study can be used to power a randomised controlled trial.