Postoperative pain after cholecystectomy: Conventional laparoscopy versus single-incision laparoscopic surgery

This study was undertaken to compare the postoperative pain after cholecystectomy done by single-incision laparoscopic surgery (SILS) versus conventional four-port laparoscopy [conventional laparoscopic surgery (CLS)]. SILS is a feasible and a promising method for cholecystectomy. It is possible to do this procedure without the use of special equipments. While there are cosmetic advantages to SILS, it is not clear whether or not the pain is also reduced.

Patients undergoing cholecystectomy for symptomatic gallstones were offered the choice of the two methods and the first 100 consecutive patients from each group were included in this observational study. Only conventional instruments were used to keep the cost of surgery comparable. Pain scores were checked 8 hours after the surgery using visual analogue score. Student's t test was done to check the statistical significance.

We observed no significant difference in the pain score between the CLS and SILS (2.78 versus 2.62). The operative time (OT) was significantly lower in the CLS group (28 versus 67 minutes). Comparing the OTs of the first 50 patients undergoing SILS with the second 50 patients showed a significantly lower OT (79 versus 54 minutes). We also compared the pain score between these three groups. The second half of SILS group had a significantly lower pain score compared to the first half (2.58 versus 2.84). This group also had a lower pain score compared to conventional laparoscopy group but the difference was not statistically significant (2.58 versus 2.78).

Although there was no significant difference in the overall postoperative pain as OT decreases with surgeon's experience in single-incision laparoscopic cholecystectomy, postoperative pain at 8 hours appears to favour this method over conventional laparoscopic cholecystectomy.