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Single-incision laparoscopic cholecystectomy: a systematic review.
Thomas C Hall1, Ashley R Dennison, Dilraj K Bilku
1Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, England. tch2@doctors.org.uk
Archives of Surgery (Chicago, Ill. : 1960)
|July 18, 2012
Summary
Single-incision laparoscopic cholecystectomy (SILC) offers no proven benefits over standard laparoscopic cholecystectomy (SLC) regarding pain or reduced trauma. Complications may be more frequent with SILC, potentially due to insufficient follow-up in studies.
Area of Science:
- Minimally Invasive Surgery
- Surgical Outcomes Research
- Gastrointestinal Surgery
Background:
- Single-incision laparoscopic cholecystectomy (SILC) is a newer technique aiming for improved cosmesis and reduced trauma.
- Standard laparoscopic cholecystectomy (SLC) remains the established method for gallbladder removal.
Purpose of the Study:
- To compare single-incision laparoscopic cholecystectomy (SILC) with standard laparoscopic cholecystectomy (SLC).
- To evaluate differences in morbidity, postoperative pain, cosmetic outcomes, and cost-effectiveness.
Main Methods:
- Systematic review of existing literature from MEDLINE up to July 31, 2011.
- Inclusion of 49 studies (2336 patients), including randomized trials and case-matched control series.
- Exclusion of case reports and series with fewer than 4 cases.
Main Results:
- Postoperative pain was similar or worse in SILC compared to SLC in 76.9% of studies reporting pain.
- Improved cosmesis was demonstrated in 3 of 6 articles investigating cosmetic outcomes.
- The overall median complication rate was 7.37%, with a biliary duct complication rate of 0.39%.
Conclusions:
- Current evidence does not definitively support improved cosmesis or reduced surgical trauma with SILC over SLC.
- Complications may be underestimated due to inadequate follow-up periods in many SILC studies.
- Concerns exist regarding potential increased complications and a shift from established safe surgical practices with SILC.