Comparison of Early Morbidity Parameters Between Single Incision Laparoscopic Cholecystectomy and Classic Laparoscopic Cholecystectomy: A Prospective Controlled Trial

Pankaj Garg, title, Jai D Thakur, MBBS, Rajeev Kumar, MBBS MS, Ashok K Attri, MBBS MS, Jeremy Song, BS. 1. SGHKS Charitable Hospital, Sohana, Mohali, Punjab, India 2. University of Arkansas for Medical Sciences, Little Rock, USA. 3.Government Medical College, Chandigarh, India. 4. Simches Research Center, Massachusetts General Hospital, Boston, USA

Aim– To compare pain and early morbidity parameters between SILS Cholecystectomy (SILS-C) and four-port classic laparoscopic cholecystectomy (CLC).
Methods – 65 patients (10 men, 55 women) were prospectively enrolled in the study and divided in two groups- SILS-C (n=35) & CLC(n=30). SILS-C was done through a transumbilical incision (2.3 to 2.7 cm) and 3 ports (one 10 mm and two 5 mm ports) were introduced separately through the incision. The surgery was done with conventional straight instruments and utilized retracting sutures through the abdominal wall. The post operative pain scores at 6 hrs, 24 hrs and 1 week were registered using visual analogue scores (VAS). Along with this, post operative nausea, vomiting, commencement of oral intake, hospital stay, days taken to resume normal activities and days taken to return back to work were noted.
Results– The mean age in SILS-C was 45.8±15.3yrs and CLC was 43.7±12.2 yrs. The age, sex, associated co-morbidities like diabetes and hypertension were similar in both the groups. The history of acute cholecystitis, jaundice and pancreatitis were also comparable in both the groups. The operating time was significantly longer in SILS-C group (78.57 ±28.5 mins) than CLC group (50.83 ± 22.6 mins)(p<0.0001, t-test). 10 out of 35 (28%) SILS-C patients required introduction of additional trocars. 5 patients required one, 3 patients required two and 2 patients required three additional trocars. The reasons for putting additional trocars were dense adhesions(5), bleeding(2), confusion in anatomy(2) and a large left lobe of liver(1). None of the patients required conversion to open. The post operative pain scores at 6 hrs (SILS-C-1.71 ± 1.8, CLC-2.00 ± 1.1, p=0.47,non-sig., t-test), 24 hrs (SILS-C-1.86 ± 1.6, CLC-1.62 ± 1.2, p=0.53,non-sig, t-test), and 1 week (SILS-C-1.16 ± 0.4, CLC-1.10 ± 0.3, p=0.57,non-sig., t-test) were similar in both the groups. The other early morbidity parameters- post operative nausea, vomiting, commencement of oral intake (SILS-C-6.06 ± 0.7 hrs, CLC-6.31 ± 1.3 hrs, p=0.48,non-sig., t-test), hospital stay (SILS-C-1.08 ± 0.6 days, CLC-1.21 ± 0.5 days, p=0.20,non-sig., t-test), days taken to resume normal day to day activities (SILS-C-7.81 ± 3.8 days, CLC-8.35 ± 2.2 days, p=0.60,non-sig., t-test) and days taken to return back to professional work (SILS-C-20.99 ± 5.8 days, CLC-20.28 ± 5.0 days, p=0.61,non-sig., t-test) – were also similar in both the groups. The wound infection causing significant morbidity (dressing >15 days) was higher in the SILS-C group [SILS-C- 11%(4/35) vs CLC-0%. P=0.082 ,non-sig., Fisher exact test]. If converted SILS-C cases were analyzed separately (SILS-C=25, CLC-29, SILS converted=10), the pain scores at 6hrs, 24 hrs (SILS-C-2.08 ± 1.9, CLC-1.62 ± 1.2, SILS-converted-1.30 ± 0.4, p=0.31,non-sig, ANOVA test), 1 week and morbidity parameters were still similar in all the three groups.
Conclusions– SILS-Cholecystectomy is a safe and viable option. It can be performed with outcome (post operative pain scores and morbidity parameters) similar to four-port classic laparoscopic cholecystectomy while having obvious cosmetic benefits at the same time. Moreover, conversion of SILS to multiport cholecystectomy (addition of ports) didn’t significantly increase post-operative pain or morbidity.