Abstract
BackgroundWithin the last years, single-incision laparoscopic cholecystectomy (SLC) emerged as an alternative to multiport laparoscopic cholecystectomy (MLC). SLC has advantages in cosmetic results, and postoperative pain seems lower. Overall complications are comparable between SLC and MLC. However, long-term results of randomized trials are lacking, notably to answer questions about incisional hernia rates, long-term cosmetic impact and chronic pain.MethodsA randomized trial of SLC versus MLC with a total of 193 patients between December 2009 and June 2011 was performed. The primary endpoint was postoperative pain on the first day after surgery. Secondary endpoints were conversion rate, operative time, intraoperative and postoperative morbidity, technical feasibility and hospital stay. A long-term follow-up after surgery was added.ResultsNinety-eight patients (50.8%) underwent SLC, and 95 patients (49.2%) had MLC. Pain on the first postoperative day showed no difference between the operative procedures (SLC vs. MLC, 3.4 ± 1.8 vs. 3.7 ± 1.9, respectively; p = 0.317). No significant differences were observed in operating time or the overall rate of postoperative complications (4.1% vs. 3.2%; p = 0.731). SLC exhibited better cosmetic results in the short term. In the long term, after a mean of 70.4 months, there were no differences in incisional hernia rate, cosmetic results or pain at the incision between the two groups.ConclusionsTaking into account a follow-up rate of 68%, the early postoperative advantages of SLC in relation to cosmetic appearance and pain did not persist in the long term. In the present trial, there was no difference in incisional hernia rates between SLC and MLC, but the sample size is too small for a final conclusion regarding hernia rates.Trial registrationGerman Registry of Clinical Trials DRKS00012447
Highlights
Since the first laparoscopic cholecystectomy was performed by Mühe et al in 1985, significant progress in the practice of Langenbecks Arch Surg (2020) 405:551–561 reports were published for elective cholecystectomy
Bleeding occurred in one patient undergoing single-incision laparoscopic cholecystectomy (SLC), and a common bile duct injury was found in a patient during multiport laparoscopic cholecystectomy (MLC), which was treated via suturing and insertion of a T-tube
Two patients planned for an MLC were converted to an open procedure due to extensive adhesions
Summary
Since the first laparoscopic cholecystectomy was performed by Mühe et al in 1985, significant progress in the practice of Langenbecks Arch Surg (2020) 405:551–561 reports were published for elective cholecystectomy. We performed a randomized trial to compare single-port with multiport laparoscopic cholecystectomy within the early days of single-port laparoscopy and added a longterm follow-up of the patients with particular focus on the development of incisional hernias and long-term cosmetic results. Long-term results of randomized trials are lacking, notably to answer questions about incisional hernia rates, long-term cosmetic impact and chronic pain. Pain on the first postoperative day showed no difference between the operative procedures (SLC vs MLC, 3.4 ± 1.8 vs 3.7 ± 1.9, respectively; p = 0.317). No significant differences were observed in operating time or the overall rate of postoperative complications (4.1% vs 3.2%; p = 0.731). After a mean of 70.4 months, there were no differences in incisional hernia rate, cosmetic results or pain at the incision between the two groups
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