الفهرس 
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Abstract
Background: Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is a commonly performed treatment modality for concomitant gallbladder stones and common bile duct stones (CBD stones). There has been a debate about the appropriate timing of laparoscopic cholecystectomy after ERCP. The present study aimed to comprehensively compare early and delayed laparoscopic cholecystectomy after ERCP for concomitant gallbladder stones and common bile duct stones using unique parameters like Nassar scale with clarification of the benefits of the appropriate timing.
Methods: In a randomized controlled trial, adult patients with concomitant gallstones and CBD stones were randomly assigned after ERCP to one of two equal groups; early and delayed laparoscopic cholecystectomy. The early cholecystectomy group underwent surgery within 72 hours of ERCP while the delayed group underwent surgery after six weeks of ERCP. Operative parameters included the operative time, the grading of adhesions, the difficulty of dissection in Calot’s triangle, bleeding, and conversion to open cholecystectomy. We also used Nassar scale (for grading of operative difficulty in laparoscopic cholecystectomy) in the comparison between the two groups and predicting the surgery outcome.
Results: The delayed cholecystectomy group was associated with significantly higher rates of acute cholecystitis while waiting for surgery, higher grades of Nassar scale, more adhesions, more operative difficulties, difficult dissection of the Calot’s triangle, and longer operative time.
Conclusion: Early laparoscopic cholecystectomy was better as it significantly had less operative time, less intraoperative difficulties, and fewer interval complications between ERCP and surgery.