THREE-PORT VERSUS FOUR - PORT LAPAROSCOPIC CHOLECYSTECTOMY A TWO YEARS EXPERIENCE AT TWO ARMED FORCES TERTIARY CARE HOSPITALS

Abstract

Objective: To compare the outcomes of three-port versus four-port laparoscopic cholecystectomy (LC) and assess the safety and efficacy of three-port LC as routine procedure.

Study Design: Retrospective comparative study.

Place and Duration of Study: Combined Military Hospital Kohat/CMH Multan, from Oct 2013 to Dec 2016.

Methodology: Total of 403 patients were selected and were divided into two groups based on the principles of non-randomized clinical trial; group A having three-port laparoscopic cholecystectomy (LC) and group B having four-port laparoscopic cholecystectomy (LC). Fourth port in right axillary line at umbilicus level was not established in group A. Outcomes were recorded in terms of operating time, complications, pain assessment/ analgesic requirement and hospital stay.

Results: A total of 218 (54.09%) patients in group A and 185 (45.91%) patients in group B were assessed. The difference in terms of verbal pain score, analgesic requirement and duration of hospital stay/return to activity were significant statistically, all being less in group A. Cosmetic outcome as perceived by patients was also better in the group A because of less numbers of scars. Operative time (minutes) was less in group A in our study (35.59 ± 10.75) as compared to group B (50.17 ± 10.14). Results of other variables including intra-operative/post-operative complications were comparable among the two groups.

Conclusion: Three-port LC has advantages of being less painful, with less analgesics requirement and reduced hospital stay without compromising the safety and efficacy. It is more acceptable to patients due to less numbers of scars and better cosmesis.