Does single port improve results of laparoscopic colorectal surgery? A propensity score adjustment analysis.

Abstract

The benefit of single-incision laparoscopy (SIL) over conventional multiport laparoscopy (ML) is not demonstrated in colorectal surgery, mainly because of potentially biased reports. The objective of this study was to compare SIL to ML for colorectal resection, using a propensity score (PS) adjusted analysis. From July 2009 to April 2013, 764 patients who underwent 799 colorectal resections by SIL or ML were analyzed. PS was estimated using a logistic regression model. Eighty-four colorectal resections were performed using SIL: 43 ileocolic resections, 15 right-sided colectomies, 14 left-sided colectomies, 5 rectal resections, 4 subtotal colectomies, and 3 total proctocolectomies. Intra-operative complications occurred in 3 procedures (4%), and conversion laparotomy in 10 (12%). Postoperative mortality was nil and overall morbidity rate was 25%, including 7% of major complications. Mean postoperative length of hospital stay was 8±6 (4-47) days. Outcomes of SIL, when compared to those of 715 ML and after PS adjustment, showed no difference in terms of intra-operative complication (p=0.315), conversion to open surgery (p=0.387), overall morbidity (p=0.393), major morbidity (p=0.381), or length of postoperative hospital stay (p=0.080). However, the length of hospital stay was significantly shorter after SIL in the right colectomy subgroup (p=0.001). In colorectal surgery, SIL appears to be safe and effective as compared to ML. It can also reduce hospital stay after right colectomy. These results, if confirmed by randomized trials, would validate SIL in colorectal surgery.