Page 34 - Laparoscopic Journal - WJOLS
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Njem Josiah Miner, RK Mishra
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complication or perioperative mortality recorded in both reported by Brittney et al. This showed a statistically
groups of patients. significant shorter length of hospital stay for patients who
The average length of hospital stay including in had SILC. Patients who had SILC stayed an average of
patient and outpatient surgeries was 23.93 ± 9.8, 7 hours less than those who had 4PLC. This result is
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4 to 48 hours for those who had SILC and 30.07 ± similar to the result of other studies who reported the
16, 8 to 72 hours for patients who underwent 4PLC mean postoperative hospital stay after SILC to be 12 hours
(p = 0.014). After undergoing SILC, 90% (54 of 60) of shorter than that of patients who had 4PLC. Prasad also
patients went home within 24 hours, while 75% (46 of reported a mean postoperative hospital stay of 0.34 days
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61) of those who had 4PLC went home within 24 hours after SILC as against 0.98 days after 4PLC. Older patients
(p = 0.05). Patients in both groups had either parace stayed longer in hospital (Table 1) which is understandable
tamol or a nonsteroidal anti-inflammatory drug (NSAID) because most of them have other comorbidities.
as postoperative analgesic. Only one (1.7%) patient who The analgesic requirement of patients who had SILC
had SILC required an NSAID for postoperative analgesia, was not quite different from that of patients who went
while 59 (98.3%) had postoperative pain relieve using through 4PLC. Although only one patient in the SILC
only paracetamol. Four (6.6%) of patients who had 4PLC group required a stronger analgesic NSAID as against
required an NSAID for postoperative analgesia, while four patients for the 4PLC group, this was not statis
57 (93.4%) had only paracetamol for postoperative anal tically significant. Other factors which other studies have
gesia (p = 0.177), which was not statistically significant. addressed either in favor or against either of the opera
The difference in analgesic requirement of males and tive procedures include cost, operative time, blood loss,
females was not statistically significant, although, more ergonomics and return to normal activity. Single inci
males tended to take stronger analgesics (Table 4). Younger sion laparoscopic cholecystectomy has been reported to
patients appeared to need stronger analgesics for pain have a slightly higher operative cost than 4PLC due to
relieve compared to older patients, (p = 0.015) (Table 5). the peculiarity of the roticulating instruments required
Followup was limited to one to two postoperative to ensure ergonomically smooth procedure. 4,14 It has
office visits. No complications were noted in this period also been reported that SILC take more operative time to
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in the two groups. complete compared to 4PLC this has been attributed to
the steep learning curve associated with SILC. This has
dISCuSSIoN
also been associated with a high conversion rate and as
Single incision laparoscopic cholecystectomy is not totally well as complications.
a new concept, it was introduced into practice as far back There was one conversion from SILC to 4PLC in
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as 1992 by Pelosi et al who performed a single puncture this study. This was a patient who had prior percuta
laparoscopic appendicectomy. First experiences with neous drainage of gallbladder empyema in another
SILC were reported by Navarra et al in 1997 and with a hospital. There was no perioperative complications in the
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different approach by Piskun and Rajpal in 1999. There two groups.
have been many studies establishing the advantages of
SILC as a complimentary or substitude surgical technique LIMITATIoNS oF THE STudY
to conventional 4PLC. This topic, however, remains This study was a retrospective nonrandomized, single
contentious and incompletely settled. center study with few patients which constituted a
This study showed that 90% of patients who had SILC limitation to the strength of its findings. The inability of
went home within 24 hours. This is similar to a study the study to also address factors, such as cost, operative
Table 4: Demographics and hospital stay
Mean Standard error 95% CI
Study parameters NSA (5) PCM (116) difference of mean Lower Upper t-value p-value
Age (years) 30.20 ± 9.96 46.62 ± 14.66 – 16.42 6.637 – 29.562 – 3.279 – 2.474 0.015*
Hospital stay (hrs) 24.80 ± 15.59 27.10 ± 13.74 – 2.296 6.310 – 14.791 10.199 – 0.364 0.717
*p-value < 0.05, statistically significant
Table 5: Hospital stay SILC vs 4PLC
Mean Standard error 95% CI
Study parameters LC (61) SILS (60) difference of mean Lower Upper t-value p-value
Age (years) 45.18 ± 14.66 46.71 ± 15.10 – 1.536 2.705 – 6.893 3.820 – 0.568 0.571
Hospital stay (hrs) 30.07 ± 16.33 23.93 ± 9.81 6.133 2.459 1.264 11.00 2.494 0.014*
*p-value < 0.05, statistically significant
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