Is single-incision laparoscopic cholecystectomy safe? Results of a systematic review and meta-analysis.
BACKGROUND
Single-incision laparoscopic cholecystectomy (SILC) is gaining popularity. It is not evident whether the benefits of this procedure overcome the potential increased risk. We performed a systematic review and meta-analysis to compare SILC with conventional multi-incision laparoscopic cholecystectomy (MILC).


METHODS
Data from randomized, controlled trials published up to December 2011 and comparing SILC versus MILC were extracted. The primary end point was overall morbidity. A fixed-effect model was applied to summarize the study outcomes in the meta-analysis, and a random-effect model was used in the sensitivity analysis. The outcome measures were relative risk (RR) and mean difference (MD); a RR of <1.0 or a negative MD indicated a more favorable outcome after SILC. Publication bias was assessed by a funnel plot, and heterogeneity was tested by the I (2) measure and subgroup analyses.


RESULTS
A total of 12 trials (996 patients) were included. Mortality was nil in both treatment groups; the overall RR for morbidity was 1.36 (p = 0.098). The mean operating time was 47.2 min for MILC and 58.1 min for SILC (MD 9.47 min; p < 0.001). The visual analog scale pain score at 24 h after surgery was 2.96 in MILC and 2.34 in SILC (MD -0.64; p = 0.058), but sensitivity analysis of the four studies deemed at low risk of bias for pain assessment, according to blinding and postoperative analgesic protocols, showed significance at -0.43 points (95 % confidence interval -0.87 to 0.00; p = 0.049). Cosmetic outcome scored better in the SILC group, with its standardized MD being equal to 1.16 (95 % confidence interval 0.57 to 1.75; p < 0.001).


CONCLUSIONS
In selected patients, SILC has similar overall morbidity compared with MILC; further, it results in better cosmetic satisfaction and reduced postoperative pain despite longer operative time.
Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy. alberto.arezzo@mac.com
Alberto
A
Arezzo
Gitana
G
Scozzari
Federico
F
Famiglietti
Roberto
R
Passera
Mario
M
Morino
D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods*; D004954:Esthetics; D006801:Humans; D061646:Operative Time; D010149:Postoperative Pain; D016032:Randomized Controlled Trials as Topic; D064232:Visual Analog Scale