Traditional 4-Port Versus Reduced Port Laparoscopic Cholecystectomy

Abstract

Introduction: Laparoscopic cholecystectomy is one of the most commonly performed surgeries worldwide by general surgeons. Improvisations, also in terms of reduction in the number and size of ports have been attempted for the same, seeking advantages of the same above the conventional four-port laparoscopic cholecystectomy.
Objective: To evaluate the advantages & efficacy of reduction in the number of ports for laparoscopic cholecystectomy.
Methods: A descriptive study of 100 cases from the Dept of General Surgery, Silchar Medical College & Hospital, Silchar, Assam, over a period of one year were analyzed.
Results.: A study of 100 patients with a female: male ratio of (18:7), of which 9 underwent 1-port LC, 52 underwent 2-port LC, 39 underwent 3-port LC. The mean operating time for 1, 2 & 3-port LC were 57.88, 42.2 & 35.68 minutes, respectively (p = 0.883) for conversion of reduced ports to conventional 4-port LC or open cholecystectomy, indicating no positive association between the number of ports & conversion. The mean number of doses of analgesia required in 3, 2 & 1-port LC were 2.23, 2.03 & 1.44 doses, respectively (p = 0.018). The mean number of post-operative days stay was 1.16, 1.04 & 1.11 days, respectively (p = 0.170), and the number of days taken for return to daily was 1.16, 1.04 and 1, respectively.
Conclusion: It was observed that the age for the prevalence of gallstone disease was most common between (21–30) years, the duration of surgery increased with the decrease in the number of ports, and the conversions were not associated with the number of ports used & so were the complications. The number of doses of analgesics required was lesser with a lesser number of ports. There was no significant difference in the duration of hospital stay. The number of days required to return to routine activities was earlier, with a lesser number of ports. The was excellent cosmesis in all the 3 types of reduced ports.
Our study showed similar results of Cassera et al., in terms of post-op complications, & pain were similar in with a decrease in the number of ports; Chow et al. showed shorter post-operative stay, which is not so in our study, which showed no significant duration of post-operative stay; Podolsky et al. expired technical difficulty with a reduction in a number of ports, which is similar to our study, where the duration of surgery increases with reduction of ports. There were certain limitations to this study including sample size being small and being from a single region is not representative of the entire community around the world. All the surgeries were performed keeping in mind the benefits that could be incurred for the patients at no added cost. There is a possibility of bias.