Abstract
BackgroundOver the past decade, mini-laparoscopic cholecystectomy (MLC) and single-port laparoscopic cholecystectomy (SILC) have been the two main successful mini-invasive surgical interventions for the treatment of cholecystolithiasis since the advent of laparoscopic cholecystectomy (LC). In this study, we conducted a meta-analysis to compare the two treatment alternatives.MethodsWe searched PubMed, CNKI and the Cochrane library for trials that compared MLC and SILC. Risk difference (RD) and mean difference (MD) were calculated with a 95% confidence interval (CI).ResultsFour randomized controlled trials (RCTs) and 2 non-randomized comparative studies (nRCSs) involving 2764 patients were identified. A longer operating time (MD -10.49; 95% CI -18.10, −2.88; P = 0.007) and a shorter wound length (MD 3.65; 95% CI 0.51, 6.78; P = 0.02) were found to be associated with SILC compared with MLC. No significant differences were revealed in conversion, hospital stay, pain relief and cosmetic results. Although a lower incidence of complications was observed with MLC (8.2%) compared with SILC (15.9%), but the difference was not statistically significant (RD -0.06; 95% CI -0.12, 0.00; P = 0.07).ConclusionsMLC has an advantage over SILC in terms of operating time rather than hospital stay, pain relief, cosmetic results. Though conversion and complication rates were higher with SILC, there existed no statistically differences in the two measures between the two procedures. Whether MLC confers any benefits in terms of conversion or complications still warrants further studies.
Highlights
Over the past decade, mini-laparoscopic cholecystectomy (MLC) and single-port laparoscopic cholecystectomy (SILC) have been the two main successful mini-invasive surgical interventions for the treatment of cholecystolithiasis since the advent of laparoscopic cholecystectomy (LC)
It had been reported that SILC could achieve better pain relief and excellent cosmetic result when compared to LC [7]
6 publications (4 Randomized controlled trial (RCT) [18,19,20,21] and 2 Non-randomized comparative study (nRCS) [22, 23]) involving 2764 patients were included for further evaluation (Table 1)
Summary
Characteristics of included studies Eight publications were full-text reviewed independently by two reviewers (Yong T and Jie B). No statistical significance (RD -0.06; 95% CI -0.12, 0.00; P = 0.07) (Fig. 5) was revealed in complications between the two procedures, a lower incidence of total complications was found (8.2%, 171/2086) in MLC group than SILC group (15.9%, 108/678). The funnel plot exhibited some bias arising from the exclusion or absence of some trials (right low part) (Additional file 2: Figure S6). We compared the pain scores of the other 4 studies and found no significant difference (MD -0.03; 95% CI -0.29, 0.23; P = 0.83) in pain relief between the two procedures (Fig. 6). One of the studies [23] reported cosmetic results in terms of the number of the patients who were satisfied with their wounds and the other four studies evaluated with a visual analogue scale. The funnel plot and sensitivity analysis were not performed due to too small a sample size
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