A Comparative Study of Single Incision vs Conventional Four Incision Laparoscopic Cholecystectomy: A Single Center Experience

Laparoscopic cholecystectomy has traditionally been performed using multiple small incisions. Single incision laparoscopic cholecystectomy (SILC) has emerged as an alternative technique to improve cosmesis and minimize complications associated with multiple incisions. This study compared SILC with conventional four incision laparoscopic cholecystectomy. Materials and methods: One hundred and twenty-one patients had laparoscopic cholecystectomy at the institute of minimal access, metabolic and bariatric surgery, Sir Ganga Ram Hospital, New Delhi, between January 2013 and October 2014. A total of 61 (50.4%) had conventional four port laparoscopic cholecystectomy (4PLC), while 60 (49.6%) had SILC. Indications for the operation were similar for the two groups. Excluded were patients who were operated for malignant gallbladder disease, patients with mirizzi syndrome, patients with gallbla dder perforation and patients who were in American Society of Anesthesiologists (ASA) 1V and V. Primary end points: Analgesic requirements, Complications and hospital visits, Length of hospital stay. Results: The average length of hospital stay including in-patient and out-patient surgeries was 23.93 ± 9.8, range 4 to 48 hours for those who had SILC and 30.07 ± 16, range 8 to 72 hours for patients who underwent 4PLC. Patients in both groups had either paracetamol or a nonsteroidal anti-inflammatory drug (NSAID) as postoperative analgesic. Only one (1.7%) patient who had SILC required an NSAID for postoperative analgesia, while 59 (98.3%) had postoperative pain relieve using only paracetamol. Four (6.6%) of patients who had 4PLC required an NSAID for postoperative analgesia, while 57 (93.4%) had only paracetamol for postoperative analgesia. Conclusion: Single incision laparoscopic cholecystectomy appears to offer prospects for shorter hospital stay and early return to work compared to conventional 4PCL. Patients undergoing either SILC or 4PLC appear to have similar analgesic requirement. Extrapolating this to pain difference between the two surgical techniques, however, requires caution. Single incision laparoscopic cholecystectomy WJOLS