Single incision laparoscopic cholecystectomy: Less scar, less pain

CONTEXT AND AIMS: Our study aims to evaluate the post-operative pain and cosmesis of single-incision laparoscopic cholecystectomy (SILC) in comparison with the standard, 3-port laparoscopic cholecystectomy (SLC) with respect to the length of incision, cosmetic scores, post-operative pain scores and duration of hospital stay. SETTINGS AND DESIGN: This comparative randomised study was conducted in a tertiary care centre teaching hospital between September 2012 and 2014. One hundred and fifty consecutive patients, who qualified as per inclusion criteria, were included in the study. SUBJECTS AND METHODS: Seventy-five patients were included in the SLC arm and 75 in the SILC arm. SILC procedure was carried out as transumbilical multiport technique and SLC as 3-port technique utilizing - 5, 5, 10 mm ports. STATISTICAL ANALYSIS USED: The data for the primary observations (post-operative pain scores, cosmetic score and incision length) and secondary observation (post-operative hospital stay) were noted. Weighted mean difference was used for calculation of quantitative variables, and odds ratios were used for pooling qualitative variables. RESULTS: Pain scores at 4 and 24 h were significantly better for SILC arm than SLC arm (at 4 h - 4.84 +/- 0.95 vs. 6.17 +/- 0.98, P < 0.05 and at 24 h - 3.84 +/- 0.96 vs. 5.17 +/- 0.09, P < 0.05). Length of incision was significantly smaller (SILC - 2.631 +/- 0.44 cm vs. SLC - 5.11 +/- 0.44 cm), P < 0.05 and cosmetic score was significantly better in SILC arm (6.25 +/- 1.24) than SLC arm (4.71 +/- 1.04), P < 0.05. Difference between the hospital stay is insignificant for two arms SILC (2.12 +/- 0.34) and SLC (2.13 +/- 0.35), P > 0.05. DISCUSSION: Significant difference was found in duration and intensity of pain between two procedures at 4 and 24 h. Cosmesis was significantly better in SILC than SLC group, the sample size in our study was small to arrive at a definite conclusion. The procedure can be selectively and judiciously performed by surgeons trained in regular laparoscopic surgery. Furthermore, the threshold for conversion should be low in learning phase. Widespread application must await Level 1 evidence from prospective trials.