F. Paul Buckley, MD, FACS, Hannah Vassaur, PAC, Joshua Crosby, BA, Daniel Jupiter, PhD. Scott & White Healthcare
Background: The feasibility of elective single-incision laparoscopic (SILS) cholecystectomy for biliary colic and dyskinesia has been well-established in the literature, but limited data has been published concerning the approach for more severe disease. A retrospective chart review was conducted to assess the safety and feasibility of the SILS approach in the setting of complicated gallbladder disease.
Methods: All SILS cholecystectomies performed at a single institution by three surgeons between November 2008 and July 2012 were reviewed. Cases with indications of acute or chronic cholecystitis were compared to the remaining cases. Statistical evaluation included descriptive analysis of demographic data and bivariate analysis of operative outcomes. Multivariate analyses were performed to control for other factors impacting outcomes.
Results: 90 SILS cholecystectomies were performed for complicated disease and 318 for uncomplicated. The data set included 315 (71.21%) women, and the patients had a mean age of 44.91 (16.84) (range 10-91) years. Mean BMI was 28.99 (6.04) (range 15.5-61). The mean operative time for complicated disease was 66.8 minutes versus 59.2 minutes for uncomplicated disease, which was significant (p=0.03). Neither conversion nor overall complication rates differed statistically significantly between complicated and uncomplicated cases (chi-squared p-values 0.33 and 0.94, respectively). Abscess formation was higher in the complicated group (3.33% versus 0.31%), which was statistically significant (Fisher’s exact p-value = 0.04). There were no common bile duct injuries in either cohort.
Conclusion: SILS cholecystectomy for complicated gallbladder disease appears to be a safe and feasible option when compared to SILS cholecystectomy performed electively. Our institution found a difference in operative length of about six minutes, but this is not unreasonable given the expectation of increased difficulty in complicated cases. Further prospective analyses comparing SILS cholecystectomy to traditional multiport laparoscopy in both complicated and uncomplicated disease are required.