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Comparison between single-incision and conventional laparoscopic cholecystectomy: a prospective trial of the Club
Philippe Hauters1, Sylvain Auvray, Jean Luc Cardin
1CH wapi site Notre-Dame, 9 Avenue Delmée, 7500 Tournai, Belgium. ph.hauters@bipweb.be
Background:
The aim of this study was to compare the outcomes of single-incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC).
Method:
Patients' inclusion criteria were uncomplicated gallstones, BMI ≤30, ASA score ≤2, and no past surgery in the upper abdomen. Five surgeons performed only SILC and seven only CLC. Data analyzed included operative time, morbidity, quality of life (QOL), cosmetic result, and global patient satisfaction. The last three parameters were evaluated 3 months after surgery. QOL was assessed with the Gastrointestinal Quality of Life Index (GIQLI) questionnaire. Cosmetic result and patient satisfaction were rated using a 5-grade Likert scale.
Results:
This study included 104 patients operated on between April and June 2010. A SILC was performed in 35 patients and a CLC in 69. The preoperative characteristics of the two groups were similar. Median operative time for SILC was higher than that for CLC: 55 versus 40 min (p < 0.001). Postoperative complications (0 vs. 2) and postoperative GIQLI scores (123 ± 13 vs. 121 ± 18) were not significantly different between groups. Cosmetic result and patient satisfaction were better for SILC than for CLC. The percentages of results rated as excellent were 68 versus 37 % (p < 0.006) and 80 versus 57 % (p < 0.039), respectively. For the whole group, multivariate statistical analysis revealed that postoperative GIQLI score and cosmetic result were independent predictive factors of patient satisfaction. The percentages of satisfaction rated as excellent were greater in patients who had a postoperative GIQLI score ≥130 (92 vs. 49 %, odds ratio [OR] = 4, p < 0.001) and in patients who had an excellent cosmetic result (82 vs. 47 %, OR = 7, p < 0.001).
Conclusions:
Compared to CLC, SILC is associated with a longer operative time, an equivalent morbidity and QOL, and a better cosmetic result. The improved aesthetic result also leads to a better global patient satisfaction.