Two-port vs four-port laparoscopic cholecystectomy - A prospective randomized controlled trial

Background: Two-port laparoscopic cholecystectomy has been reported to be safe and feasible. However, whether it offers any additional advantages remains controversial. This study reports a randomized trial that compared the clinical outcomes of two-port laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Methods: One hundred and twenty consecutive patients who underwent elective laparoscopic cholecystectomy were randomized to receive either the two-port or the four-port technique. All patients were blinded to the type of operation they underwent. Four surgical tapes were applied to standard four-port sites in both groups at the end of the operation. All dressings were kept intact until the first follow-up 1 week after surgery. Postoperative pain at the four sites was assessed on the first day after surgery using a 10-cm unsealed visual analog scale (VAS). Other outcome measures included analgesia requirements, length and difficulty of the operation, postoperative stay, and patient satisfaction score on surgery and scars. Results: Demographic data were comparable for both groups. Patients in the two-port group had shorter mean operative time (54.6 +/- 24.7 min vs 66.9 +/- 33.1 min for the four-post group; p = 0.03) and less pain at individual subcostal port sites [mean score using 10-cm unscaled VAS: 1.5 vs 2.8(p = 0.01) at the midsubcostal port site and 1.3 vs 2.3(p = 0.02) at the lateral subcostal port site]. Overall pain score, analgesia requirements, hospital stay, and patient satisfaction score on surgery and scars were similar between the two groups. Conclusion: Two-port laparoscopic cholecystectomy resulted in less individual port-site pain and similar clinical outcomes but fewer surgical scars compared to four-port laparoscopic cholecystectomy. Thus, it can be recommended as a routine procedure in elective laparoscopic cholecystectomy.