This study assessed the outcome of 342 patients with in situ gallbladders undergoing ERCP for suspected choledocholithiasis. The result of ERCP was found to play a significant role (P < 0.0001) in determining whether patients were subsequently managed conservatively (n = 152) or underwent either laparoscopic (n = 110) or open (n = 80) surgery. Those undergoing laparoscopic surgery were noted to be younger (P = 0.0001) and were less likely to be jaundiced (P = 0.0015) or have CBD stones at ERCP (P = 0.0295). In 28 patients with CBD stones remaining after ERCP, pre- rather than postoperative timing of ERCP prevented a potential second operation. The current success rate of 85% in clearing CBD stones at ERCP cannot support a routine policy of intraoperative cholangiography followed by postoperative ERCP.