A retrospective comparison of two-, three-, and four-port laparoscopic cholecystectomies

Abstract

Purpose: A total of 1276 laparoscopic cholecystectomies (LCs) using two-, three-, and four-port methods were analyzed to evaluate the feasibility and effectiveness of two and three-port LCs in management for acute or elective gallstone disease when compared with four-port LC. Materials and Methods: A between-group comparison was performed on the difference of operation time, postsurgery admission days, postsurgery daily pain score between acute or elective surgery or different procedures. Results: Proportion of four-port LC was significant high in acute then in elective surgery (93.3% vs. 79.0%; P = 0.001). In elective surgeries, difference among mean operative time of two-, three-, and four-port LC (36.76, 34.72, and 27.32 min, respectively) was statistically significant (P = 0.001). Three-port LC showed a significant lowest mean pain score (1.887; 1 to 10 point pain score) on the first-day post-LC.(P = 0.04) Difference on the mean post-LC hospitalization of two-, three-, and four-port LCs (2.158, 2.141 and 2.412 days, respectively) were significant in elective (P = 0.001) while not significant in acute surgery (two-, three-, and four-port LCs: 2.75, 2.778, and 3.097 days, respectively; P = 0.237). Conclusions: Four-port LC was the procedure of choice in acute surgery. The operative time was the shortest for four and longest for two-port LC. Three-port LC could be adopted using strategic selection (elective surgery) and conversion (with adding port) as safety guard for the benefits of less wound pain, decreased post-LC admission days.