A case-control study of single-incision versus standard laparoscopic cholecystectomy

Single-incision laparoscopic cholecystectomy (SILC) has been increasingly performed recently. Although it seems plausible that SILC will be associated with less pain compared to standard 4-port laparoscopic cholecystectomy (LC), there is currently no conclusive comparative study on the postoperative pain issues of SILC against LC.

In this retrospective, case-control study, 30 patients who had SILC over a 6-month period were compared with a matched (sex, age group, race) group of 30 patients who underwent LC. Verbal pain score (VPS) on postoperative days (POD) 1, 2, 3, and 5; pain sites; analgesic requirement; and number of days (NoD) required to return to normal activities were compared.

There were 4 (13%) acute cholecystitis cases in each group. Average VPS on POD 1, 2, 3, and 5 of SILC and (LC) cholecystectomy patients were 4.53 (5.14) (P=0.09), 3.43 (3.83) (P=0.36), 2.07 (2.52) (P=0.25), and 1.13 (1.24) (P=0.69), respectively. In the SILC group, 26 patients (87%) had umbilical pain, whereas in the LC group, 25 patients (83%) had similar symptoms. Epigastric pain was experienced by 5 patients in the two groups, and RHC pain was experienced by 1 patient in the SILC group (3%) and 2 patients in the LC group (7%). The SILC and the LC patients required 4.00 and 4.90 days (P=0.09) of paracetamol, respectively, to control pain. The NoD required before return to normal activity in the SILC and LC groups was 5.97 days and 7.79 days (P=0.008), respectively.

There was no statistically significant difference in postoperative pain, pain site and analgesia requirement; however, patients who underwent SILC returned to their normal activity 1.8 days earlier than the LC patients. Larger RCTs are needed to compare postoperative outcomes between SILC and LC.