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M Patel et al 10.5005/jp-journals-10033-1219
OriginaL articLe

Pain and Cosmesis following Four-Port Laparoscopic

Cholecystectomy: The Patient View

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1 M Patel, CP Neal, AR Dennison, MS Metcalfe, G Garcea
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ABSTRACT managed. The standard four-port laparoscopic cholecystec-
Introduction: The standard four-port laparoscopic cholecys- tomy (SLC) is the current gold-standard of surgical treat-
tectomy (SLC) is presently the gold standard in gallbladder ment, and remains the primary technique employed for the
surgery in the United Kingdom. The introduction of single port 60,000 cholecystectomies performed annually within the
laparoscopic cholecystectomy (SILC) is said to offer potential 1
improvements in pain and cosmesis postoperatively. This study United Kingdom. In an attempt to reduce operative trauma
surveyed patient satisfaction at each of their port sites following and improve cosmetic results, there is a trend toward mini-
uncomplicated four-port cholecystectomy. mising the number of incisions with the use of single-port
Materials and methods: Retrospective postal questionnaire laparoscopic cholecystectomy (SILC) and natural orifice
poll of 100 patients aged between 18 and 82. A ten-point visual
analog score was used to assess postoperative pain at each transluminal endoscopic surgery (NOTES). Our aim was to
respective port site within the first 72 hours. A similar scale was investigate patient satisfaction with the standard four-port
used to assess cosmetic satisfaction relating to scar color, stiff- technique by assessing postoperative pain and cosmetic
ness, thickness and irregularity. Patients were asked whether or
not they would prefer a single incision operation based on their result scores as well overall satisfaction in an attempt to
experience of the standard four-port technique. identify whether a single-incision technique would help us
Results: Sixty-one patients returned their questionnaires to provide a more acceptable patient experience.
(61% response rate). The median pain scores were highest at
the umbilical port site the epigastric port site collectively had MATeRIALS AND MeThoDS
the worst cosmetic outcome in terms of satisfaction with scar
color, stiffness, thickness and irregularity. 79.7% of patients were Study Protocol open Access
satisfied with the four-port procedure and only 20.3% would have
preferred a single-port operation if given the option. The study consisted of a retrospective postal questionnaire
Conclusion: Patient satisfaction with standard four-port chole- poll of 100 patients aged between 18 and 82. Inclusion
cystectomy is high. The umbilical port was consistently the most
painful postoperatively, with cosmesis scores being worst for the criteria included patients who had undergone an elective
epigastric port site. However, there is no firm data that would SLC (all performed by the same surgeon) within the last
support SILC over SLC based on this evidence. 6 months (from December 2011 to May 2012). Those
Keywords: Cosmesis, Pain, Scar, Port site, Cholecystectomy. who required conversion to open cholecystectomy were
How to cite this article: Patel M, Neal CP, Dennison AR, Met- excluded from this study. Questionnaires were timed to be
calfe MS, Garcea G. Pain and Cosmesis following Four-Port received at 2 months following surgery. A ten-point visual
Laparoscopic Cholecystectomy: The Patient View. World J Lap
Surg 2014;7(2):66-68. analog score (zero = no pain, ten = severe pain) was used to
Source of support: Nil assess postoperative pain scores (within the first 24 hours)
Conflict of interest: None at the four respective port sites. A similar scale was used to
assess cosmetic satisfaction relating to scar color, stiffness,
INTRoDuCTIoN thickness and irregularity (zero = like normal skin, ten =
very different to normal skin). Patients were asked to report
Over the last two decades, minimally invasive surgery has port site wound infections and overall satisfaction with their
revolutionized the way in which symptomatic gallstones are
operation. More specifically, they were asked whether or not
they would prefer a single incision operation based on their
experience of the standard four-port technique.
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1,2 Specialist Trainee, Consultant
1,2 Department of General Surgery, University Hospitals of operating Technique
Leicester, Leicester, United Kingdom
A standard four-port technique utilizing 10 mm incisions at
3-5 Department of Hepatobiliary and Pancreatic Surgery
University Hospitals of Leicester, Leicester, United Kingdom the umbilicus and epigastric region, with two lateral 5 mm
Corresponding Author: M Patel, Specialist Trainee, Depart- retraction ports. The gallbladder was retrieved from the
ment of General Surgery, University Hospitals of Leicester epigastric port site using a standard commercially available
Leicester, LE5 4PW, United Kingdom, Phone: 0116 258 446 endoscopic retrieval bag. All port sites were infiltrated with
Fax: 0116 268 4708, e-mail: meerapatel@doctors.org.uk
local anesthetic postprocedure (Fig. 1).
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