A prospective, randomized comparison of pain, inflammatory response, and short-term outcomes between single port and laparoscopic cholecystectomy

Abstract

The purpose of this study was to compare the postoperative inflammatory response and severity of pain between single-incision laparoscopic surgery (SILS) cholecystectomy and conventional laparoscopic cholecystectomy (LC). Two groups of 20 patients were prospectively randomized to either conventional LC or SILS cholecystectomy. Serum interleukin-6 (IL-6) levels were assayed before surgery, at 4-6 h, and at 18-24 h after the procedure. Serum C-reactive protein (CRP) levels also were assayed at 18-24 h after surgery. Pain was measured at each of three time points after surgery using the visual analogue scale (VAS). The number of analgesia doses administered in the first 24 h after the procedure also was recorded and 30-day surgical outcomes were documented. The groups had equivalent body mass index (BMI), age, and comorbidity distribution. Peak IL-6 levels occurred 4-6 h after surgery, and the median level was 12.8 pg/ml in the LC and 8.9 pg/ml in the SILS group (p = 0.5). The median CRP level before discharge was 1.6 mg/dl in the LC and 1.9 mg/dl in the SILS group (p = 0.38). There was no difference in either analgesic use or pain intensity as measured by the VAS between the two groups (p = 0.72). The length of the surgical procedure was significantly longer in the SILS group (p < 0.001). No intraoperative complications occurred in either group. Single-incision laparoscopic surgery does not significantly reduce systemic inflammatory response, postoperative pain, or analgesic use compared with LC.