Page 30 - Peer Reviewed Laparoscopic Jornal

Chukwuemeka Chukwunwendu Osuagwu

pressure at the port sites. Postoperative pain parameter was cystectomy due to upper abdominal adhesions obscuring
22
accessed in all the randomized controlled trials. There was port placement. This is an unusual conversion which
no difference in the severity of postoperative pain should be borne in mind as an advantage of single port
experienced by the study group and controls. 24,26,28 Other laparoscopic cholecystectomy.
authors noted that postoperative pain was lower in patients
who underwent conventional laparoscopic cholecystectomy Postoperative Wound Infections and
16
25
(p = 0.04, p = 0.028). Some results noted that single Other Wound Complications
port laparoscopic cholecystectomy resulted in less Wound hematoma was noted in three cases of single incision
23
22
postoperative pain as (p = 0.001, p = 0.002). These laparoscopic surgery compared to four cases observed
conflicting results may arise from the difference in the timing following conventional laparoscopic cholecystectomy this
24
used in assessing the postoperative pain.
is similar to about 17 cases observed in a review of 1,180
30
cases. Wound infections were uncommon, and occurred
Cosmesis and Body Image
more frequently in the single port laparoscopic chole-
Cosmetic appearance of the abdominal wound after surgery cystectomy, and was statistically significant (p = 0.04). 25
was assessed using the scar satisfaction scale. Cosmesis was This may be due to the pressure necrosis from the snugly fit
assessed in all the studies reviewed except for Tsimoyiannis port a well as extraction of the inflamed gallbladder through
18
et al. The cosmetic outcome was in favor of single port the umbilicus. Umbilical hernia occurred more frequently
laparoscopic cholecystectomy except for one study that following single port laparoscopic cholecystectomy. Other
26
reported that there was no difference. Another study noted studies found that these were evenly distributed between
that the reported difference was not statistically significant. 23 the two arms; however, umbilical incisional hernia may
25
However, seven of the studies reviewed reported a better be related more to technical failure in the repair of the
cosmetic appearance outcome 16,22,24,25,27-29 which where umbilical port.
statistically significant. The study that detected the highest
statistically significant difference in cosmesis (p = 0.0002) CONCLUSION
had assessed cosmesis after single port laparoscopic The randomized controlled trial that were available were
24
cholecystectomy at 2 weeks. All the cosmetic evaluations relatively few, and the sample sizes were small, this may
in clinical trials reviewed were done within the first 3 months explain the failure to detect statistically significant
of surgery. The cosmetic appearance of conventional differences in many of the safety criteria evaluated.
laparoscopic cholecystectomy after 4 years was judged to However, improved cosmesis is the most consistent benefit
be excellent by a retrospective study. 31,32 This may be derived from the trials, it is also noteworthy that bile duct
considered in choosing the between single port leaks were low and no mortality was reported. These
cholecystectomy and conventional laparoscopic
cholecystectomy. remarkably good outcomes may be spurious considering
the meticulous criteria adopted in selecting the patients that
Bile Duct Injuries and Conversion participated in this study. Large scale multicenter trials are
needed to challenge the findings in this review.
Bile duct injuries were uncommon in the studies reviewed.
Two cases of postoperative bile duct leaks were reported REFERENCES
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96