Single-incision versus conventional laparoscopic cholecystectomy: a meta-analysis

Abstract

Conventional laparoscopic cholecystectomy (CLC) is now accepted as the gold standard surgical treatment for gallbladder stone disease. Single-incision laparoscopic technology has recently been introduced into laparoscopic clinical practice in order to reduce the invasiveness of this procedure. A meta-analysis of randomized clinical trials (RCTs) was performed to compare single-incision laparoscopic cholecystectomy (SICL) and CLC. Medline, Embase, ISI Web of Knowledge CPCI-S and the Cochrane Library were searched and the methodological quality of the included trials was evaluated. Outcomes evaluated were adverse events, conversion rate, post-operative hospital stay, blood loss, post-operative pain, total wound length, operative time and wound satisfaction score. Results were pooled in meta-analyses as odds ratio and weighted mean differences (WMD). Five RCTs on 264 patients qualified for the meta-analysis, 139 being allocated to SILC and 125 to CLC. There was no significant difference between SICL and CLC for adverse events, conversion rate, post-operative hospital stay, blood loss, post-operative pain and total wound length; however, operative time was significantly longer in SICL than in CLC (WMD 7.72 (95% confidence interval (CI): 1.38-14.07) min; P = 0.02, χ(2) P = 0.02, I(2) = 69%). Furthermore, wound satisfaction score was significantly higher in SICL than in CLC (WMD 1.40 (95% CI: 1.19-1.61) min; P < 0.00001, χ(2) P = 0.19, I(2) = 42%). SILC may be superior to CLC in terms of cosmetic outcome, but not in operative time. Currently, SILC is a safe procedure for proper patients in experienced surgeons.