Published online Nov 21, 2013. doi: 10.3748/wjg.v19.i43.7743
Revised: August 17, 2013
Accepted: September 15, 2013
Published online: November 21, 2013
Processing time: 198 Days and 9.3 Hours
AIM: To compare the clinical outcome of single-incision laparoscopic cholecystectomy (SILC) and three-incision laparoscopic cholecystectomy (3ILC) for acute cholecystitis.
METHODS: From July 2009 to September 2012, 136 patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral hospital. One experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes, straight instruments, and conventional ports. Five patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were excluded. The remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic findings. Patient demography, clinical data, operative results and complications were recorded and analyzed.
RESULTS: Fifty patients with gangrenous cholecystitis, gallbladder empyema, or hydrops were classified as the complicated group, and 58 patients with acute cholecystitis were classified as the uncomplicated group. Twenty-three (46.0%) of the patients in the complicated group (n = 50) and 39 (67.2%) of the patients in the uncomplicated group (n = 58) underwent SILC; all others underwent 3ILC. The postoperative length of hospital stay (PLOS) was significantly shorter in the SILC subgroups than the 3ILC subgroups (3.5 ± 1.1 d vs 4.6 ± 1.3 d, P < 0.01 in the complicated group; 2.9 ± 1.1 d vs 3.7 ± 1.4 d, P < 0.05 in the uncomplicated group). The maximum body temperature recorded at day 1 and at day 2 following the procedure was lower in the SILC subgroups, but the difference reached statistical significance only in the uncomplicated group (37.41 ± 0.56 °C vs 37.80 ± 0.72 °C, P < 0.05 on postoperative day 1; 37.10 ± 0.43 °C vs 37.57 ± 0.54 °C, P < 0.01 on postoperative day 2). The operative time, estimated blood loss, postoperative narcotic use, total length of hospital stay, conversion rates, and complication rates were similar in both SILC and 3ILC subgroups. The complicated group had longer operative time (122.2 ± 35.0 min vs 106.6 ± 43.6 min, P < 0.05), longer PLOS (4.1 ± 1.3 d vs 3.2 ± 1.2 d, P < 0.001), and higher conversion rates (36.0% vs 19.0%, P < 0.05) compared with the uncomplicated group.
CONCLUSION: SILC is safe and efficacious for patients with acute cholecystitis. The main benefit is a faster recovery than that achieved with 3ILC.
Core tip: single-incision laparoscopic cholecystectomy (SILC) is an alternative treatment for uncomplicated benign gallbladder diseases, but its role in acute cholecystitis remains unclear. This comparative analysis of SILC with three-incision laparoscopic cholecystectomy for treating acute cholecystitis represents the largest series to date and proportion of gangrenous cholecystitis patients (30.6%). The well-known drawbacks of SILC - longer operative time and higher cost - were alleviated by the larger paraumbilical incisions facilitating extraction of inflamed gallbladders and reliance on conventional instruments only. The low procedure conversion rate observed for SILC indicated its safety and efficacy for treating acute cholecystitis. SILC providing a faster recovery time was the main benefit to these patients.