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Doing “LESS” is Beneficial -Combining ERCP and Cholecystectomy

August 26, 2020 7:00 am

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.

Key findings:

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.

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