Page 17 - World Journal of Laparoscopic Surgery

WJOLS

Comparison of Three-port vs Four-port Laparoscopic Cholecystectomy in a Medical College in the Periphery
The mean operative time of three-port LC was The average hospital stay of patients was 1.1 days
33.66 minutes and for four-port LC was 33.33 minutes, (1–2 days) in the three-port procedure. Length of hos-
9
and it was statistically insignificant. Among the variables pital stay was similar in three-port and four-port LCs
8
studied, only mean operative time was statistically sig- (p = 0.312). Hospital stay was significantly less in three-
nificant, with the LC one-port technique showing a longer port group compared with the four-port group (p < 0.004)
duration of the surgical procedure (p = 0.007). 1 owing to postoperative pain score. 14
The mean operating time in the three-port group In the postoperative period, during hospital stay and
(44.00 ± 7.217 minutes) and four-port group (47.60 ± 6.633) during follow-up visits at 1 week, 1, 2, and 3 months,
14
was comparable (p = 0.073). In our study, it was taken patients were asked for evaluation of their respective
as time from skin incision to skin closure. Also, as the operations. Factors included were improvement in symp-
experience of the surgeons grows in both the procedures, toms, return to normal activity, and cosmetic results. More
the operative time decreases. than 77% patients in both the groups had assessed their
Drain was used in nine patients (30%) of group I and respective procedures as good. Only 18% of the patients
four patients (13%) of group II. On the 1st postoperative assessed their procedures as very good, but none com-
day, mean volume drained in four-port LC group was plained of poor outcome after their operation.
8.66 ± 22.85 mL and in three-port LC group, this was Regarding evaluation of cosmetic results, patients in
24.66 ± 33.80 mL. both the groups had accepted their scars as cosmetically
The volume of fluid in drain was more in three-port good.
LC group than in four-port LC group, and this difference The difference in patient acceptance for the two
is statistically significant (p < 0.05). groups is not statistically significant, so it can be said
Drains were necessary in 20 (20%) of the three-port that the outcome of both the operations for the patients
procedure patients, and all drains were removed by the is similar.
1st postoperative day. 8 Three-port LC is technically feasible, is safe, achieves
Assessment of pain was done by the number of doses good results, and is similar to those achieved with the
of the analgesic required by the patients in the first four-port technique, with less postoperative analgesia,
48 hours in both the groups. Analgesic used in the study less assistance, and less number of scars, and so had better
was injection diclofenac. It was seen that the mean anal- cosmetic appearance and was less expensive. Hence, we
gesic required in group I was 1.10 doses as compared 9
with 1.03 doses in group II. Ten percent patients of both recommend it as a routine procedure in elective LC.
The most important aspect of any surgical procedure
the groups required only two injections of diclofenac.
The mean analgesic requirement in four-port LC is is its safety and complications. Some surgeons have
less than that of three-port LC, but the difference is not expressed concerns about the safety of the three-port
statistically significant. technique, arguing that it may lead to a higher percentage
15
Pain scores showed differences during the recovery of bile duct injuries.
time, with less pain in the LC one port, but at 4 and In our study the process of pneuoperitoneum creation
24 hours, there were no differences. At 5 and 8 days, in both these groups was done either by open or closed
patients from the LC one-port group reported more pain method randomly as the two methods are equally effec-
16
than the LC two-port or LC three-port groups. 1 tive and feasible as evidenced in literature.
Postoperative pain (p < 0.008) and analgesic require-
ment (p < 0.001) were significantly less in the three-port CONCLUSION
group when compared with the four-port group. 14 We conclude that both three-port LC and four-port LC
In the present study, patients were discharged from are equally good techniques in the hands of experienced
the hospital when they were fit and after getting their laparoscopic surgeons, with comparable operative time,
consent to go home. The mean hospital stay in three- pre- and postoperative complications, analgesic require-
port LC group was 3 days as compared with 4 days in ment, hospital stay, cosmesis, and disability days. The
the four-port LC group. Some of the patients wanted four-port technique should be accepted and adopted
to go home after the removal of their stitches, as the only by surgeons experienced in laparoscopic surgery
cost of transportation to their villages was more than and familiar with the three-port technique as it is more
the cost of stay in the hospital. This factor was kept in difficult to perform, particularly in patients with adhe-
mind while discharging the patients, and this led to sions. The operator who performs the three-port LC
late discharge of some of the patients. The difference should be prepared for placement of an additional port
in mean hospital stay in both the groups is statistically or conversion to open laparotomy whenever complica-
not significant. tion arises.
World Journal of Laparoscopic Surgery, January-April 2017;10(1):12-16 15