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Gastro 2016
August 11-12, 2016
Volume 6, Issue 4(Suppl) J Gastrointest Dig Syst 2016
ISSN:2161-069X JGDS, an open access journal
conferenceseries .com
August 11-12, 2016 Birmingham, UK
6th Global Gastroenterologists Meeting
Manish Madnani, J Gastrointest Dig Syst 2016, 6:4(Suppl)
Growing smaller: Single incision laparoscopic cholecystectomy; patient’s vision and surgeon’s scope
Manish Madnani
Narayana Multispeciality Hospital, India
Introduction: Laparoscopic cholecystectomy is considered as a gold standard for the surgical treatment of gallstone disease,
which results in less post-operative pain, better cosmesis and shorter hospital stay than open cholecystectomy. In 1997, Navarra
et al. described a single-incision laparoscopic cholecystectomy as a possible alternative procedure to the four port laparoscopic
cholecystectomy. The present study is to compare Standard 4 Port Laparoscopic Cholecystectomy (S4PLC) and Single Incision
Laparoscopic Cholecystectomy (SILC), in terms of safety, surgeon comfort, pain scores and final cosmetic appearance of scar.
Patients & Methods: At three different centers of India, total 372 patients were operated for laparoscopic cholecystectomy
during July 2013 to December 2014. Patients who met exclusion criteria were not followed up for further data collection. Total
53 patients in SILC and 61 patients in S4PLC group were studied prospectively without randomization (patient autonomy
was preserved). All the acquired data was filled in SPSS IBM 20.0 version and statistical analysis was done. Chi square test for
qualitative data, Student’s ‘t’ Test for quantitative data, Mann Whitney U test for non-parametric data and ANOVA/MANOVA
(multivariate analysis) tests for distribution of variances were used.
Results: Young patients selected SILC over S4PLC when given options of both. Mean age in SILC group was 39.87 (range 19-
70), while it was 50.43 in S4PLC group (range 26-78). There were 35 (66%) females and 18 (34%) males in SILC group while in
S4PLC group there were 33 (54%) females and 28 (46%) males, though this difference was not statistically different. SILC and
S4PLC were comparable in incidence of intra-operative (11.3% vs. 9.8%) (p>0.05), immediate (1.9% vs. 4.9%) (p>0.05) and late
post-operative complications (5.7% vs. 3.5%) (p>0.05), with a same follow up duration. It was observed that SILC and S4PLC
both had no difference in post-operative pain (2.94±1.56 vs. 2.9±1.58) and analgesic requirement (28.3% vs. 27.6%). Dissection
during surgery in Calot’s triangle was not felt to be difficult by the operating surgeon in both types of surgery, as difficulty was
encountered in 7.54% in SILC while in 9.83% in S4PLC group (p=0.764). Though surgeons’ physical comfort and ergonomics
were better with S4PLC than with SILC (p=0.001). Use of additional ports was required in more number of cases in SILC
than in S4PLC (22.64% vs. 6.55%, p=0.044). Duration of surgery was longer in SILC than in S4PLC (70.26±44.8 vs. 58.64±
45.76, p=0.002). Post-operative hospital stay (31.21±15.91 vs. 33.59±14.21, p=0.094) and day of suture removal (7.21±1.34 vs.
7.31±1.39, p=0.426) was same with both procedures. Cosmetic appearance of scar is significantly better with SILC than with
S4PLC (3.4±1.2 vs. 2.51±1.53, p<0.0001), which has impact on overall patient satisfaction (happy or very happy: 94.3% vs.
78.7%, p=0.001).
Conclusion: SILC is a method of laparoscopic cholecystectomy with better cosmetic advantage than conventional laparoscopic
cholecystectomy. But this advantage comes at the cost of longer duration of surgery, difficult posturing, ergonomics for surgeon
and other technical difficulties. Hence, SILC should only be offered to patients in whom it is anticipated to be smooth, who
have greater concern for cosmesis and only by the surgeon who has enough experience of performing this procedure.
Biography
Manish Madnani has completed his Super Specialty in Surgical Gastroenterology from National Board of Examinations of India. He is a Consultant Surgical
Gastroenterologist, Hepatobiliary and Pancreatic Surgeon at Narayana Multispeciality Hospital, Ahmedabad, India. He has published 3 papers in reputed journals,
wrote a chapter in textbook, an article in local medical association’s magazine. He has been serving as an Editorial Board Member of reputed medical journals.