A recent retrospective study (DS Fishman et al. JPGN 2020; 71: 203-207) identified 25 patients who underwent combined Laparascopic cholecystectomy/ERCP in Same Session (=LESS) to more conventional ERCP followed by laparoscopic cholecystectomy (n=42). The center utilized prospectively-collected data from 13 centers and 67 consecutive ERCPs.
- Median hospital stay was shorter for LESS patients, 3 days vs. 4 days (P=.32)
- Total procedure time was similar, though a decrease in total anesthesia time was reported for LESS patients: mean 177 minutes compared to 205 minutes (P=.04)
- No significant adverse events were reported in either group, though both groups had two patients who required repeat care due to suspected retained stones
- The authors note that concerns about gaseous distention following ERCP “is likely unfounded as all cholecystectomies were completed.”
- No local or systemic infections were reported. The authors recommend antibiotic prophylaxis with the LESS approach
My take: Given the recommendation that cholecystectomy should take place during the same hospitalization for patients with choledocholithiasis, this combined approach makes a lot sense and is supported by this study.