title: Systematic review and meta-analysis of randomized clinical trials comparing single-incision versus conventional laparoscopic cholecystectomy.
abstract: BACKGROUND
  Single-incision laparoscopic cholecystectomy (SILC) may offer advantages over conventional laparoscopic cholecystectomy (LC).
  
  
  METHODS
  MEDLINE, Embase, PubMed, CINAHL, Cochrane Central Register of Controlled Trials and the Cochrane Library were searched for randomized clinical trials on SILC versus LC until May 2012. Odds ratio (OR) and weight mean difference (WMD) were calculated with 95 per cent confidence intervals (c.i.) based on intention-to-treat analysis.
  
  
  RESULTS
  Thirteen randomized clinical trials included a total of 923 procedures. SILC had a higher procedure failure rate than LC (OR 8·16, 95 per cent c.i. 3·42 to 19·45; P < 0·001), required a longer operating time (WMD 16·55, 95 per cent c.i. 9·95 to 23·15 min; P < 0·001) and was associated with greater intraoperative blood loss (WMD 1·58, 95% of c.i. 0·44 to 2·71 ml; P = 0·007). There were no differences between the two approaches in rate of conversion to open surgery, length of hospital stay, postoperative pain, adverse events, wound infections or port-site hernias. Better cosmetic outcomes were demonstrated in favour of SILC as measured by Body Image Scale questionnaire (WMD -0·97, 95% of c.i. -1·51 to -0·43; P < 0·001) and Cosmesis score (WMD -2·46, 95% of c.i. -2·95 to -1·97; P < 0·001), but this was based on comparison with procedures in which multiple and often large ports (10 mm) were used.
  
  
  CONCLUSIONS
  SILC has a higher procedure failure rate with more blood loss and takes longer than LC. No trial was adequately powered to assess safety.
authors.affiliation: Department of General and Oncological Surgery, University of Perugia, Perugia, Italy. stefano.trastulli@hotmail.it
authors.forename: S
authors.initials: S
authors.lastname: Trastulli
authors.forename: R
authors.initials: R
authors.lastname: Cirocchi
authors.forename: J
authors.initials: J
authors.lastname: Desiderio
authors.forename: S
authors.initials: S
authors.lastname: Guarino
authors.forename: A
authors.initials: A
authors.lastname: Santoro
authors.forename: A
authors.initials: A
authors.lastname: Parisi
authors.forename: G
authors.initials: G
authors.lastname: Noya
authors.forename: C
authors.initials: C
authors.lastname: Boselli
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D015982:Bias; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001828:Body Image; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005705:Gallbladder Diseases / Q000601:surgery*; D046449:Hernia, Abdominal / Q000209:etiology; D006801:Humans; D007902:Length of Stay; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards; D013530:Surgical Wound Infection / Q000209:etiology; D017211:Treatment Failure