A Case–control Study of Single-Incision Versus Standard Laparoscopic Cholecystectomy

Single-incision laparoscopic cholecystectomy (SILC) has been increasingly performed recently. Although it seems plausible that SILC will be associated with less pain compared to standard 4-port laparoscopic cholecystectomy (LC), there is currently no conclusive comparative study on the postoperative pain issues of SILC against LC.

In this retrospective, case–control study, 30 patients who had SILC over a 6-month period were compared with a matched (sex, age group, race) group of 30 patients who underwent LC. Verbal pain score (VPS) on postoperative days (POD) 1, 2, 3, and 5; pain sites; analgesic requirement; and number of days (NoD) required to return to normal activities were compared.

There were 4 (13%) acute cholecystitis cases in each group. Average VPS on POD 1, 2, 3, and 5 of SILC and (LC) cholecystectomy patients were 4.53 (5.14) (P = 0.09), 3.43 (3.83) (P = 0.36), 2.07 (2.52) (P = 0.25), and 1.13 (1.24) (P = 0.69), respectively. In the SILC group, 26 patients (87%) had umbilical pain, whereas in the LC group, 25 patients (83%) had similar symptoms. Epigastric pain was experienced by 5 patients in the two groups, and RHC pain was experienced by 1 patient in the SILC group (3%) and 2 patients in the LC group (7%). The SILC and the LC patients required 4.00 and 4.90 days (P = 0.09) of paracetamol, respectively, to control pain. The NoD required before return to normal activity in the SILC and LC groups was 5.97 days and 7.79 days (P = 0.008), respectively.

There was no statistically significant difference in postoperative pain, pain site and analgesia requirement; however, patients who underwent SILC returned to their normal activity 1.8 days earlier than the LC patients. Larger RCTs are needed to compare postoperative outcomes between SILC and LC.