BACKGROUND:Single-incision laparoscopic cholecystectomy (SILC) is gaining popularity. It is not evident whether the benefits of this procedure overcome the potential increased risk. We performed a systematic review and meta-analysis to compare SILC with conventional multi-incision laparoscopic cholecystectomy (MILC). METHODS:Data from randomized, controlled trials published up to December 2011 and comparing SILC versus MILC were extracted. The primary end point was overall morbidity. A fixed-effect model was applied to summarize the study outcomes in the meta-analysis, and a random-effect model was used in the sensitivity analysis. The outcome measures were relative risk (RR) and mean difference (MD); a RR of <1.0 or a negative MD indicated a more favorable outcome after SILC. Publication bias was assessed by a funnel plot, and heterogeneity was tested by the I (2) measure and subgroup analyses. RESULTS:A total of 12 trials (996 patients) were included. Mortality was nil in both treatment groups; the overall RR for morbidity was 1.36 (p = 0.098). The mean operating time was 47.2 min for MILC and 58.1 min for SILC (MD 9.47 min; p < 0.001). The visual analog scale pain score at 24 h after surgery was 2.96 in MILC and 2.34 in SILC (MD -0.64; p = 0.058), but sensitivity analysis of the four studies deemed at low risk of bias for pain assessment, according to blinding and postoperative analgesic protocols, showed significance at -0.43 points (95 % confidence interval -0.87 to 0.00; p = 0.049). Cosmetic outcome scored better in the SILC group, with its standardized MD being equal to 1.16 (95 % confidence interval 0.57 to 1.75; p < 0.001). CONCLUSIONS:In selected patients, SILC has similar overall morbidity compared with MILC; further, it results in better cosmetic satisfaction and reduced postoperative pain despite longer operative time.

Is single-incision laparoscopic cholecystectomy safe? Results of a systematic review and meta-analysis

AREZZO, Alberto;SCOZZARI, Gitana;FAMIGLIETTI, FEDERICO;MORINO, Mario
2013-01-01

Abstract

BACKGROUND:Single-incision laparoscopic cholecystectomy (SILC) is gaining popularity. It is not evident whether the benefits of this procedure overcome the potential increased risk. We performed a systematic review and meta-analysis to compare SILC with conventional multi-incision laparoscopic cholecystectomy (MILC). METHODS:Data from randomized, controlled trials published up to December 2011 and comparing SILC versus MILC were extracted. The primary end point was overall morbidity. A fixed-effect model was applied to summarize the study outcomes in the meta-analysis, and a random-effect model was used in the sensitivity analysis. The outcome measures were relative risk (RR) and mean difference (MD); a RR of <1.0 or a negative MD indicated a more favorable outcome after SILC. Publication bias was assessed by a funnel plot, and heterogeneity was tested by the I (2) measure and subgroup analyses. RESULTS:A total of 12 trials (996 patients) were included. Mortality was nil in both treatment groups; the overall RR for morbidity was 1.36 (p = 0.098). The mean operating time was 47.2 min for MILC and 58.1 min for SILC (MD 9.47 min; p < 0.001). The visual analog scale pain score at 24 h after surgery was 2.96 in MILC and 2.34 in SILC (MD -0.64; p = 0.058), but sensitivity analysis of the four studies deemed at low risk of bias for pain assessment, according to blinding and postoperative analgesic protocols, showed significance at -0.43 points (95 % confidence interval -0.87 to 0.00; p = 0.049). Cosmetic outcome scored better in the SILC group, with its standardized MD being equal to 1.16 (95 % confidence interval 0.57 to 1.75; p < 0.001). CONCLUSIONS:In selected patients, SILC has similar overall morbidity compared with MILC; further, it results in better cosmetic satisfaction and reduced postoperative pain despite longer operative time.
2013
27
7
2293
2304
http://link.springer.com/article/10.1007%2Fs00464-012-2763-9
Cholecystectomy; Instruments; Systematic review; Meta-analysis; Single-port laparoscopy
Alberto Arezzo;Gitana Scozzari;Federico Famiglietti;Roberto Passera;Mario Morino
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/126844
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