Single-Port Versus Conventional Multiport Laparoscopic Cholecystectomy: A Meta-analysis of Randomized Controlled Trials and Nonrandomized Studies

Abstract

Although current guidelines recommend performing cholecystectomy via laparoscopy, consensus on the application of single-incision laparoscopic surgery for cholecystectomy is still lacking. The aim of the current study was to perform a meta-analysis of randomized controlled trials (RCTs) and nonrandomized comparative studies (NRCSs), comparing single-port laparoscopic cholecystectomy (SPLC) and conventional multiport laparoscopic cholecystectomy (CMLC) for benign gallbladder diseases. A systematic review of the literature was performed to identify studies published between January 1997 and December 2012 comparing SPLC and CMLC. Operative outcomes, postoperative parameters, complications, cosmetic results, and quality of life were evaluated. Forty studies were included in the analyses (16 RCTs, 24 NRCSs) that included 3711 patients (1865 SPLCs, 1846 CMLCs). SPLC had higher conversion rates (odds ratio [OR], 4.21; 95% confidence interval [CI], 2.71-6.56; P<.001), longer operating time (mean difference [MD], 16.1; 95% CI, 9.93-22.26 minutes; P<.001), and shorter hospital stay (MD, 0.16; 95% CI, -0.28 to -0.04 day; P=.01) than CMLC. There were no significant differences between the two procedures for early (MD, -0.1; 95% CI, -0.44 to 0.24; P=.57) or late (MD, -0.13; 95% CI, -0.45 to 0.19; P=.42) visual analog scale pain scores and overall complications (OR, 1.21; 95% CI, 0.92-1.61; P=.18). Cosmetic outcomes favored SILC at 2 weeks (MD, -1.39; 95% CI, -2.66 to -0.12; P=.03) and 1 month (MD, -0.13, 95% CI, -2.05 to 0.55; P=.0007) after surgery (index score, 0-10). SPLC can be performed safely and effectively with better cosmetic results than with the CMLC technique for benign gallbladder diseases.