Inflammation in LESS Versus Laparoscopic Cholecystectomy

Fernando A V Madureira, SAGES, TCBC, MsC, Phd, Jose Eduardo Ferreira Manso, TCBC, MsC, Phd, Delta Madureira, TCBC, MsC, Phd, Antonio Carlos Garrido Iglesias, TCBC, MsC, Phd


Introduction:Laparoendoscopic single-site surgery (LESS), has emerged as a technique that uses a natural scar, the umbilicus within a multiple entry portal into a 3,0 to 4,0 cm single incision to perform operations. The present study aimed to compare the inflammatory impact of classic video laparoscopic cholecystectomy (LC) versus LESS cholecystectomy.

Methods: A prospective randomized controlled study was conducted from January to June 2011 at two University Hospitals in Rio de Janeiro, Brazil. Fifty-seven patients (53 women, 4 men; mean age: 48.7 years) were randomly assigned to receive LC (n = 29) or LESS (n = 28) cholecystectomy. C-reactive protein (CRP) and interleukin 6 (IL-6) were measured from blood samples collected during induction of anesthesia and at three and 24 hours postoperatively. Skin and aponeurosis wound sizes were recorded. A 10-point visual analogue scale (VAS) was used for pain at post-operative hours 3 and 24. Healing and wound complications were assessed at follow-up.

Results: The mean umbilical incision length was 4.0 cm (2.1–5.8) in LESS and 2.7 cm (1.5–5.1) in LC (P < .0001). The mean internal aponeurosis diameter was 3.5 cm (2.0–5.5) in LESS and 2.3 cm (1.2–3.5) in LC (P < .0001). Median IL-6 levels in the LESS and LC groups, respectively, were 2.96 and 4.5 pg/mL preoperatively, 11.6 and 28.05 pg/mL at three hours postoperatively (P = .029), and 13.18 and 15.1 pg/mL at 24 hours postoperatively (P = .52). The mean VAS score for pain at hour 3 was 2.0 points(0–7) in LESS and 4.0 (0–10) in LC group (p=0.07), at postoperative hour 24 was 0,3 points (0–6) in LESS and 2,3 (0–10) in LC (p=0.03).There were no significant between-group differences in wound complications, and no incisional hernias occurred.

Conclusions: LESS Cholecystectomy requires a larger size incision than LC. We found a tendency of less postoperative pain following LESS cholecystectomy than LC. There was also a tendency towards lower early inflammatory impact following LESS cholecystectomy versus LC.

Keywords: cholecystectomy, laparoscopy, interleukin-6, LESS, inflammation, acute-phase reaction

Session: Poster Presentation

Program Number: P473

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