An "all 5-mm ports" versus conventional ports approach to laparoscopic cholecystectomy and Nissen fundoplication: a randomized clinical trial.
BACKGROUND
Although needlescopic surgery may reduce postoperative pain, the use of 3-mm instruments is cumbersome and has not gained popularity. We have described an "all 5-mm ports" approach to laparoscopic cholecystectomy (LC) and Nissen fundoplication (LNF).


METHODS
Selected patients were randomized to undergo LC or LNF using either the "all 5-mm ports" approach (group 1) or the conventional approach (group 2) that used two 10-mm ports and two or three 5-mm ports. The patients and investigator were blinded to the size of ports used.


RESULTS
Forty patients (20 in each group) were randomized. The groups were comparable for age, sex, and type and duration of surgery. No significant reductions in analgesic requirements at 7 days or in pain scores at 4 and 24 hours postoperatively were detected with the "all 5-mm ports" approach. However, the cosmetic satisfaction scores with the body (P=0.029), incisions (P=0.015), and scars (P=0.023) 4 weeks after surgery were significantly higher in group 1.


CONCLUSIONS
The "all 5-mm ports" approach to LC and LNF in selected patients did not offer clear advantages over the conventional approach in terms of postoperative pain or analgesic requirements. Nevertheless, the former approach enjoyed a superior cosmetic outcome and patient acceptability.
Abbas
Muhammad Hasan
MH
Queen's Hospital, Burton-upon-Trent, UK. mhabbas71@googlemail.com
Hamade
Ayman
A
Nadeem
Rana
R
Ammori
Basil
B
D000328:Adult; D001828:Body Image; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011028:Pneumoperitoneum, Artificial; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom