Original Article

Journal of Gastrointestinal Surgery

, Volume 15, Issue 4, pp 614-622

Evaluating Systemic Stress Response in Single Port vs. Multi-Port Laparoscopic Cholecystectomy

  • Colleen G. C. McGregorAffiliated withDepartment of Biosurgery and Surgical Technology, Imperial College London, Academic Surgical Unit, St Mary’s HospitalDepartment of Biosurgery and Surgical Technology, Division of Surgery, Academic Surgical Unit, Imperial College London Email author 
  • , Mikael H. SodergrenAffiliated withDepartment of Biosurgery and Surgical Technology, Imperial College London, Academic Surgical Unit, St Mary’s Hospital
  • , Alec AslanyanAffiliated withDepartment of Biosurgery and Surgical Technology, Imperial College London, Academic Surgical Unit, St Mary’s Hospital
  • , Victoria J. WrightAffiliated withDivision of Infectious Diseases, Department of Medicine, Imperial College London
  • , Sanjay PurkayasthaAffiliated withDepartment of Biosurgery and Surgical Technology, Imperial College London, Academic Surgical Unit, St Mary’s Hospital
  • , Ara DarziAffiliated withDepartment of Biosurgery and Surgical Technology, Imperial College London, Academic Surgical Unit, St Mary’s Hospital
  • , Paraskevas ParaskevaAffiliated withDepartment of Biosurgery and Surgical Technology, Imperial College London, Academic Surgical Unit, St Mary’s Hospital

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Abstract

Background and Aims

Acute-phase proteins and inflammatory cytokines mediate measurable responses to surgical trauma, which are proportional to the extent of tissue injury and correlate with post-operative outcome. By comparing systemic stress following multi-port (LC) and single-incision laparoscopic cholecystectomy (SILC), we aim to determine whether reduced incision size induces a reduced stress response.

Methods

Thirty-five consecutive patients were included, 11 underwent SILC (mean ± SEM; age 44.8 ± 3.88 year; BMI 27 ± 1.44 kg/m2) and 24 underwent LC (56.17 ± 2.80 year; 31.72 ± 1.07 kg/m2, p < 0.05). Primary endpoint measures included levels of interleukin-6 and C-reactive protein measured pre- and post-operatively. Length-of-stay (LOS) and postoperative morbidity were secondary endpoints.

Results

No statistically significant differences were found between SILC and LC for interleukin-6 and C-reactive protein levels, LOS and duration of surgery. There was also no correlation between systemic stress response and operative parameters. There were no intra-operative complications.

Conclusion

SILC appears to be a safe, feasible technique with potential advantages of cosmesis, reduced incisional pain, and well-being recommending its use. These data indicate no difference in systemic stress and morbidity between SILC and LC. A larger, multi-centred, randomised prospective trial is warranted to further investigate and confirm this finding.

Keywords

Cytokines Acute phase response Single incision laparoscopic surgery (SILS) Cholecystectomy