A COMPARATIVE STUDY OF SINGLE PORT LAPAROSCOPIC CHOLECYSTECTOMY SURGERY VERSUS MULTIPLE PORT CHOLECYSTECTOMY SURGERY

Dr (Lt Col) Chandan Kumar Thakur; Dr (Gp Capt) R Gangawatiker

Volume : IX, Issue : V, May - 2020

A COMPARATIVE STUDY OF SINGLE PORT LAPAROSCOPIC CHOLECYSTECTOMY SURGERY VERSUS MULTIPLE PORT CHOLECYSTECTOMY SURGERY

Dr Lt Col Chandan Kumar Thakur, Dr Gp Capt R Gangawatiker

Abstract :

Treatment of gall stones have evolved markedly since open cholecystectomy was first described by Langenbuch in 1881. Management has progressed through eras of nonsurgical management, laparotomy, minilaparotomy and now laparoscopic cholecystectomy which is the gold standard for the treatment of gall stone disease today. Laparoscopic surgery is the procedure of choice for most benign gall bladder diseases unless obvious contraindication exists. OBJECTIVES: To evaluate the efficacy and effectiveness of single port laparoscopic cholecystectomy compared to the conventional multiport laparoscopic cholecystectomy with respect to:– (1) Time required for surgery (2) Post operative pain (3) Morbidity and complications (4) Conversion rates METHODS: This comparative randomised study was conducted in a tertiary care centre teaching hospital between Sep 2011 to Feb 2013. Study design: 100 consecutive patients who fit into the inclusion criteria were included in the study. 50 patients were included in the multiport cholecystectomy arm and 50 in the single port cholecystectomy arm. Random allocation of patients presenting with symptoms suggestive of gall bladder disease with confirmatory USG study was done to the two groups using the sealed envelope technique which was opened just before the skin incision. The two groups were as follows Group1: SINGLE PORT UMBILICAL SURGERY Group2: MULTIPLE PORT LAPAROSCOPIC SURGERY The details of preoperative assessment, intraoperative observation, postoperative course and postoperative follow up ere recorded in a proforma.Statistical analysis was carried out and all the observations and results were evaluated to arrive at a conclusion. RESULTS: Majority of presenting patients were in age group 40–50 years. There was no significant difference in the mean age of patients operated by the two techniques. 64% of the operated patients were males and 36% females and there was no significant difference among the two groups.Significant difference in the conversion rate was found in the two groups the conversion rate for single port cholecystectomy was 12%. No statistically significance rise in surgical complications occurred in the patients operated by single port technique as compared to multiport surgery. Median time required to complete cholecystectomy by single port technique was significantly higher than that required for multiport cholecystectomy. No difference was found in the duration of postoperative pain experienced in the two groups. Postoperative complaints of nausea and vomiting occurred in almost equal number of patients in the two groups. Patients operated by single port technique had a postoperative hospital stay of mean 2.12 days, almost same as for patients operated by multiport technique. Significant postoperative port site infections was observed with the Single Port Cholecystectomy. INTERPRETATION & CONCLUSION: Technical difficulty and inflammatory changes due to chronic cholecystitis are the leading causes of conversion from single port to multiport cholecystectomy. Time required for single port surgery is significantly higher than multiport cholecystectomy. Postoperative port site infection was significantly higher in single port cholecystectomy as compared to multiple port cholecystectomy. The sample size in our study is small to make solid conclusion. The procedure can be selectively and judiciously performed by surgeons trained in regular laparoscopic surgery. Also the threshold for conversion should be low in learning phase. Widespread application must await results obtained from level 1 trials.