title: Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy.
abstract: BACKGROUND
  Minimally invasive techniques have become an integral part of general surgery with recent investigation into single-incision laparoscopic cholecystectomy (SILC). This study presents the final 1-year results of a prospective, randomized, multicenter, single-blinded trial of SILC vs multiport cholecystectomy (4PLC).
  
  
  METHODS
  Patients with biliary colic and documented gallstones or polyps or with biliary dyskinesia were randomized to SILC vs 4PLC. Data measures included operative details, adverse events, and conversion to 4PLC or laparotomy. Patients were followed for 12 months.
  
  
  RESULTS
  Two hundred patients underwent randomization to SILC (n = 119) or 4PLC (n = 81). Enrollment ranged from 1 to 50 patients with 4 sites enrolling >25 patients. Total adverse events were not significantly different between groups (36% 4PLC vs 45% SILC; p = 0.24), as were severe adverse events (4% 4PLC vs 10% SILC; p = 0.11). Incision-related adverse events were higher after SILC (11.7% vs 4.9%; p = 0.13), but all of these were listed as mild or moderate. Total hernia rates were 1.2% (1 of 81) in 4PLC patients vs 8.4% (10 of 119) in SILC patients (p = 0.03). At 1-year follow-up, cosmesis scores continued to favor SILC (p < 0.0001).
  
  
  CONCLUSIONS
  Results of this trial show SILC to be a safe and feasible procedure when compared with 4PLC, with similar total adverse events but with an identified significant increase in hernia formation. Cosmesis scoring and patient preference at 12 months continue to favor SILC, and more than half of the patients were willing to pay more for a single-site surgery over a standard laparoscopic procedure. Additional longer-term population-based studies are needed to clarify if this increased rate of hernia formation as compared with 4PLC will continue to hold true.
authors.affiliation: Department of Surgery, University Hospitals of Cleveland, Case Medical Center, Cleveland, OH 44106, USA. jeffrey.marks@uhhospitals.org
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Marks
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Phillips
authors.forename: Roberto
authors.initials: R
authors.lastname: Tacchino
authors.forename: Kurt
authors.initials: K
authors.lastname: Roberts
authors.forename: Raymond
authors.initials: R
authors.lastname: Onders
authors.forename: George
authors.initials: G
authors.lastname: DeNoto
authors.forename: Gary
authors.initials: G
authors.lastname: Gecelter
authors.forename: Eugene
authors.initials: E
authors.lastname: Rubach
authors.forename: Homero
authors.initials: H
authors.lastname: Rivas
authors.forename: Arsalla
authors.initials: A
authors.lastname: Islam
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Soper
authors.forename: Paraskevas
authors.initials: P
authors.lastname: Paraskeva
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosemurgy
authors.forename: Sharona
authors.initials: S
authors.lastname: Ross
authors.forename: Sajani
authors.initials: S
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000601:surgery*; D006555:Hernia, Ventral / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D020706:Laparoscopes; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult