title: Remains of the day: biliary complications related to single-port laparoscopic cholecystectomy.
abstract: OBJECTIVE
  To assess the rate of bile duct injuries (BDI) and overall biliary complications during single-port laparoscopic cholecystectomy (SPLC) compared to conventional laparoscopic cholecystectomy (CLC).
  
  
  METHODS
  SPLC has recently been proposed as an innovative surgical approach for gallbladder surgery. So far, its safety with respect to bile duct injuries has not been specifically evaluated. A systematic review of the literature published between January 1990 and November 2012 was performed. Randomized controlled trials (RCT) comparing SPLC versus CLC reporting BDI rate and overall biliary complications were included. The quality of RCT was assessed using the Jadad score. Analysis was made by performing a meta-analysis, using Review Manager 5.2. This study was based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A retrospective study including all retrospective reports on SPLC was also performed alongside.
  
  
  RESULTS
  From 496 publications, 11 RCT including 898 patients were selected for meta-analysis. No studies were rated as high quality (Jadad score ≥ 4). Operative indications included benign gallbladder disease operated in an elective setting in all studies, excluding all emergency cases and acute cholecystitis. The median follow-up was 1 mo (range 0.03-18 mo). The incidence of BDI was 0.4% for SPLC and 0% for CLC; the difference was not statistically different (P = 0.36). The incidence of overall biliary complication was 1.6% for SPLC and 0.5% for CLC, the difference did not reached statistically significance (P = 0.21, 95%CI: 0.66-15). Sixty non-randomized trials including 3599 patients were also analysed. The incidence of BDI reported then was 0.7%.
  
  
  CONCLUSIONS
  The safety of SPLC cannot be assumed, based on the current evidence. Hence, this new technology cannot be recommended as standard technique for laparoscopic cholecystectomy.
authors.affiliation: Pierre Allemann, Nicolas Demartines, Markus Schäfer, Department of Visceral Surgery, University Hospital CHUV, CH 1011 Lausanne, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Allemann
authors.affiliation: Pierre Allemann, Nicolas Demartines, Markus Schäfer, Department of Visceral Surgery, University Hospital CHUV, CH 1011 Lausanne, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.affiliation: Pierre Allemann, Nicolas Demartines, Markus Schäfer, Department of Visceral Surgery, University Hospital CHUV, CH 1011 Lausanne, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Schäfer
mesh_terms: D001652:Bile Ducts / Q000293:injuries*; D001660:Biliary Tract Diseases / Q000209:etiology*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D006801:Humans; D061214:Patient Safety; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Bile ducts; Cholecystectomy; Single incision; Single port