To compare single incision laparoscopic cholecystectomy with standard laparoscopic cholecystectomy for treatment of symptomatic cholelithiasis: a prospective randomized study

Abstract

Background:SILC can best be described as a procedure in evolution. There is no consensus on surgical technique and exclusion criteria for SILC and conflicting reports regarding the merits and demerits of this procedure are present in literature. Efforts to improve outcomes of laparoscopic cholecystectomy heralded the advent of single incision laparoscopic cholecystectomy. The objective of this study was to evaluate and compares single incision laparoscopic cholecystectomy (SILC) with standard four port laparoscopic cholecystectomy (SLC).

Methods: All the 80 patients were operated by the same surgeon, all adult patients (>18years of age) with symptomatic cholelithiasis were included and were randomized to two groups, group A consisting of 40 patients undergoing SILC and group B consisting of 40 patients undergoing SLC. Patients with acute cholecystitis, empyema gall bladder, obstructive jaundice, choledocholithiasis, H/O ERCP or pancreatitis, previous abdominal surgery, pregnancy and major comorbidity were excluded. Results were compared with those of standard laparoscopic cholecystectomy (SLC).

Results:The mean operating time was 58.73 minutes as compared to 45.10 mins in SLC. Conversion to SLC was required in 4 patients with SILC and 4 patients’ required one extra port. Mean VAS pain scores at 1hours (6.18 versus 6.53, p=0.206), at 6 hours (5.6 versus 6.12, p=0.112), and next morning (4.85 versus 4.75, p=0.772). Mean VAS score (9.27 versus 6.67, p=0.05) and mean VCS score (1.25 versus 4.05, p=0.04) for cosmesis. Additional analgesic was required in 32.5% versus 45% (p= 0.251). Significance was calculated by student "t" test. A p value less than .05 was considered significant.

Conclusions:Transumblical SILC is a superior alternative when cosmesis is considered and is comparable to SLC in terms of post-operative pain, hospital stay but the operative time is significantly more.