Endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for gallbladder with common bile duct stones: new simultaneous surgical technique

Endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for gallbladder with common bile duct stones: new simultaneous surgical technique | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for gallbladder with common bile duct stones: new simultaneous surgical technique Bin Liang, Jinchan Zhou, Liangshi Liu, Xin Qin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8186864/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Jan, 2026 Read the published version in Digestive Diseases and Sciences → Version 1 posted 4 You are reading this latest preprint version Abstract ERCP combined with laparoscopic cholecystectomy has gradually become a common one-stage treatment method for this type of disease in recent years. However, although this plan has achieved the resolution of all problems under a single anesthesia, the successive surgeries have prolonged the operation and anesthesia time. The intraoperative position changes have increased the difficulty of anesthesia management and the risk of neurovascular damage to patients. For the first time, we have reported the simultaneous completion of ERCP combined with laparoscopic cholecystectomy in the entire supine position, which is of great significance for simplifying the process, ensuring patient safety, and embodying the concepts of minimally invasive and enhanced recovery after surgery. Figures Figure 1 Figure 2 Clinical case A 65-year-old man was referred with 10-year cholelithiasis and 1-month abdominal pain. His CT demonstrated cholecystitis with multiple gallbladder calculi and cholangitis with a stone in the distal common bile duct (CBD). (Fig. 1) Under general anesthesia, the patient remained supine throughout the single-session treatment. A 5.9 mm duodenoscope, a 0.035-inch guidewire, an endoscopic sphincterotomy (10 mm), a balloon sweep (8 mm × 3 cm), and an peroral choledochoscopy were used to confirm complete clearance of the CBD. A 7-Fr, 5-cm nasobiliary drain was left for drainage. Without repositioning, three-port laparoscopic cholecystectomy was completed simultaneously. Total operative time (skin-to-skin) was 60 min; blood loss was 10 ml. (Fig. 2 and Video 1) On postoperative day 1, the nasobiliary drain was removed, and the liquid diet was resumed without post-ERCP pancreatitis. The patient was discharged in postoperative day 3, with no complications during 4-week follow-up. Declarations Author contributions X Qin conceived and designed the study. B Liang and JC Zhou wrote the draft and video editing. All authors performed the surgical procedure. All authors read and approved the final manuscript. Funding sources This work had no funding sources. Data Availability No datasets were generated or analyzed during the current study. Conflict of interest All authors declares that they have no conflict of interest. Informed consent Informed consent was obtained from the patient to publish these images. Consent for publication Written informed consent was obtained from the patient for the publication of their information and imaging. References Kattih O, Velanovich V. Comparing One-Stage vs Two-Stage Approaches for the Management of Choledocholithiasis[J]. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, 2023, 27(3): 534–543. Lau J Y W, Leow C-K, Fung T M K, et al. Cholecystectomy or gallbladder in situ after endoscopic sphincterotomy and bile duct stone removal in Chinese patients[J]. Gastroenterology, 2006, 130(1): 96–103. Joliat G-R, Kobayashi K, Hasegawa K, et al. Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022[J]. World Journal of Surgery, 2023, 47(1): 11–34. Additional Declarations No competing interests reported. Supplementary Files Video1.mp4 Cite Share Download PDF Status: Published Journal Publication published 04 Jan, 2026 Read the published version in Digestive Diseases and Sciences → Version 1 posted Editorial decision: Revision requested 01 Dec, 2025 Editor assigned by journal 25 Nov, 2025 Submission checks completed at journal 24 Nov, 2025 First submitted to journal 23 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8186864","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":550754103,"identity":"a3bfddc7-693b-4dc1-b072-b67ece40078a","order_by":0,"name":"Bin Liang","email":"","orcid":"","institution":"First Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Liang","suffix":""},{"id":550754104,"identity":"b466a7ca-78c4-4373-8ac4-aaf1f5c7ad50","order_by":1,"name":"Jinchan Zhou","email":"","orcid":"","institution":"First Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Jinchan","middleName":"","lastName":"Zhou","suffix":""},{"id":550754105,"identity":"dccccee9-a65f-440c-bf84-df90b3ab3327","order_by":2,"name":"Liangshi Liu","email":"","orcid":"","institution":"First Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Liangshi","middleName":"","lastName":"Liu","suffix":""},{"id":550754106,"identity":"fec4b2eb-cd2a-4aa3-b3b5-43bc307aaed8","order_by":3,"name":"Xin Qin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYJACZiDmYZN///FBQkUN8Vrk+BkSjA0enDlGvBZjyYYEM8mHLcyElcvPSH4mXbhjW+KGAwfSKhIb2Bj427sT8Gph7DlmJj3zzO3EDQcbjt1I3CHDIHHm7Ab8jmLvYTbmbQNqOczYdiPxDBuDgUQufi1szDxQLceY2QoS25gJa+Fh72F8DNRiLNnDxsZAlBYJnmOGj2e23Zbjl+Bhlkg4c4yHoF+AIfbgcGHbbR42CR7Gjz8qauT423vxa8F0KWnKR8EoGAWjYBRgBQB1HUazIS1C7QAAAABJRU5ErkJggg==","orcid":"","institution":"First Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":true,"prefix":"","firstName":"Xin","middleName":"","lastName":"Qin","suffix":""}],"badges":[],"createdAt":"2025-11-23 16:53:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8186864/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8186864/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10620-025-09639-y","type":"published","date":"2026-01-04T15:57:09+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":97271044,"identity":"f2d1b330-220b-4b6a-a8e7-3671071646d3","added_by":"auto","created_at":"2025-12-02 14:59:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":67363,"visible":true,"origin":"","legend":"\u003cp\u003eAbdominal CT scan shows stones in the distal common bile duct(A) and the gallbladder(B) (red arrow)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8186864/v1/418a93946968e2f6082e8056.png"},{"id":97271045,"identity":"a7fbe8d7-18c8-4893-96df-6e32e3e8b7dc","added_by":"auto","created_at":"2025-12-02 14:59:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":725669,"visible":true,"origin":"","legend":"\u003cp\u003eSurgeons, assistants, and equipment locations\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8186864/v1/87114d4e7bb40a6b75ff9a4e.png"},{"id":99545229,"identity":"24d671cd-6448-41bf-a5e0-09d53d263fc1","added_by":"auto","created_at":"2026-01-05 16:02:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1052356,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8186864/v1/b3e63d54-09ca-4c8b-a432-343c71fc9319.pdf"},{"id":97271046,"identity":"e042e382-661d-4507-be15-8fe34e993859","added_by":"auto","created_at":"2025-12-02 15:00:08","extension":"mp4","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":469700503,"visible":true,"origin":"","legend":"","description":"","filename":"Video1.mp4","url":"https://assets-eu.researchsquare.com/files/rs-8186864/v1/578c36a550b08a18ca26aa0d.mp4"}],"financialInterests":"No competing interests reported.","formattedTitle":"Endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for gallbladder with common bile duct stones: new simultaneous surgical technique","fulltext":[{"header":"Clinical case","content":"\u003cp\u003eA 65-year-old man was referred with 10-year cholelithiasis and 1-month abdominal pain. His CT demonstrated cholecystitis with multiple gallbladder calculi and cholangitis with a stone in the distal common bile duct (CBD). (Fig. 1)\u003c/p\u003e\n\u003cp\u003eUnder general anesthesia, the patient remained supine throughout the single-session treatment. A 5.9 mm duodenoscope, a 0.035-inch guidewire, an endoscopic sphincterotomy (10 mm), a balloon sweep (8 mm × 3 cm), and an peroral choledochoscopy were used to confirm complete clearance of the CBD. A 7-Fr, 5-cm nasobiliary drain was left for drainage. Without repositioning, three-port laparoscopic cholecystectomy was completed simultaneously. Total operative time (skin-to-skin) was 60 min; blood loss was 10 ml. (Fig. 2 and Video 1)\u003c/p\u003e\n\u003cp\u003eOn postoperative day 1, the nasobiliary drain was removed, and the liquid diet was resumed without post-ERCP pancreatitis. The patient was discharged in postoperative day 3, with no complications during 4-week follow-up.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eX Qin conceived and designed the study. B Liang and JC Zhou wrote the draft and video editing. All authors performed the surgical procedure. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding sources\u0026nbsp;\u003c/strong\u003eThis work had no funding sources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e No datasets were generated or analyzed during the\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ecurrent study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e All authors declares that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from the patient to publish these images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003eWritten informed consent was obtained from the patient for the publication of their information and imaging.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKattih O, Velanovich V. Comparing One-Stage vs Two-Stage Approaches for the Management of Choledocholithiasis[J]. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, 2023, 27(3): 534\u0026ndash;543.\u003c/li\u003e\n\u003cli\u003eLau J Y W, Leow C-K, Fung T M K, et al. Cholecystectomy or gallbladder in situ after endoscopic sphincterotomy and bile duct stone removal in Chinese patients[J]. Gastroenterology, 2006, 130(1): 96\u0026ndash;103.\u003c/li\u003e\n\u003cli\u003eJoliat G-R, Kobayashi K, Hasegawa K, et al. Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022[J]. 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