Skip to main content
Log in

Postoperative complications following single-incision laparoscopic cholecystectomy: a retrospective analysis in 360 consecutive patients

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Single-incision laparoscopic cholecystectomy (SILC) is being increasingly performed based on recent evidence showing its cosmetic advantages. However, there is limited information on outcome data for SILC with respect to postoperative complications.

Methods

We retrospectively reviewed a consecutive series of 360 patients undergoing SILC to evaluate the rate, features, and risk factors of postoperative complications.

Results

During a median follow-up period of 671 days, 17 patients (4.7 %) developed postoperative complications, including bile duct injuries, intraabdominal abscess, wound infection, incisional hernia, paralytic ileus, and pneumonia. Reoperation was required in five patients (1.4 %). Overall inpatient mortality occurred in one patient (0.3 %) who developed aspiration pneumonia. In multivariate stepwise regression analyses, poor physical status (American Society of Anesthesiologists score of 3) and preoperative diagnosis of acute cholecystitis were identified as significant risk factors for the development of postoperative complications (P = 0.0009 and P = 0.04, respectively).

Conclusions

These findings suggest that SILC is a relatively safe procedure with an acceptable postoperative complication rate but requires careful attention especially in patients with poor physical status and/or acute cholecystitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84(5):695

    Article  CAS  PubMed  Google Scholar 

  2. Piskun G, Rajpal S (1999) Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A. 9(4):361–364

    Article  CAS  PubMed  Google Scholar 

  3. Hernandez JM, Morton CA, Ross S, Albrink M, Rosemurgy AS (2009) Laparoendoscopic single site cholecystectomy: the first 100 patients. Am Surg 75(8):681–685 discussion 5-6

    PubMed  Google Scholar 

  4. Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N, Mavridou P et al (2010) Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 24(8):1842–1848

    Article  PubMed  Google Scholar 

  5. Cao ZG, Cai W, Qin MF, Zhao HZ, Yue P, Li Y (2011) Randomized clinical trial of single-incision versus conventional laparoscopic cholecystectomy: short-term operative outcomes. Surg Laparosc Endosc Percutan Tech. 21(5):311–313

    Article  PubMed  Google Scholar 

  6. Marks J, Tacchino R, Roberts K, Onders R, Denoto G, Paraskeva P et al (2011) Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg 201(3):369–372 discussion 72-3

    Article  PubMed  Google Scholar 

  7. Garg P, Thakur JD, Garg M, Menon GR (2012) Single-incision laparoscopic cholecystectomy vs. conventional laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Gastrointest Surg 16(8):1618–1628

    Article  PubMed  Google Scholar 

  8. Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L, Kinross J, Paraskeva P (2012) Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surg Endosc 26(5):1205–1213

    Article  CAS  PubMed  Google Scholar 

  9. Phillips MS, Marks JM, Roberts K, Tacchino R, Onders R, DeNoto G et al (2012) Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy. Surg Endosc 26(5):1296–1303

    Article  PubMed  Google Scholar 

  10. Trastulli S, Cirocchi R, Desiderio J, Guarino S, Santoro A, Parisi A et al (2012) Systematic review and meta-analysis of randomized clinical trials comparing single-incision versus conventional laparoscopic cholecystectomy. Br J Surg 100(2):191–208

    Article  PubMed  Google Scholar 

  11. Arezzo A, Scozzari G, Famiglietti F, Passera R, Morino M (2013) Is single-incision laparoscopic cholecystectomy safe? Results of a systematic review and meta-analysis. Surg Endosc 27(7):2293–2304

    Article  PubMed  Google Scholar 

  12. Geng L, Sun C, Bai J (2013) Single incision versus conventional laparoscopic cholecystectomy outcomes: a meta-analysis of randomized controlled trials. PLoS ONE 8(10):e76530

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Leung D, Yetasook AK, Carbray J, Butt Z, Hoeger Y, Denham W et al (2012) Single-incision surgery has higher cost with equivalent pain and quality-of-life scores compared with multiple-incision laparoscopic cholecystectomy: a prospective randomized blinded comparison. J Am Coll Surg 215(5):702–708

    Article  PubMed  Google Scholar 

  14. Zapf M, Yetasook A, Leung D, Salabat R, Denham W, Barrera E et al (2013) Single-incision results in similar pain and quality of life scores compared with multi-incision laparoscopic cholecystectomy: a blinded prospective randomized trial of 100 patients. Surgery 154(4):662–670 discussion 70-1

    Article  PubMed  Google Scholar 

  15. Joseph M, Phillips MR, Farrell TM, Rupp CC (2012) Single incision laparoscopic cholecystectomy is associated with a higher bile duct injury rate: a review and a word of caution. Ann Surg 256(1):1–6

    Article  PubMed  Google Scholar 

  16. Hall TC, Dennison AR, Bilku DK, Metcalfe MS, Garcea G (2012) Single-incision laparoscopic cholecystectomy: a systematic review. Arch Surg 147(7):657–666

    Article  PubMed  Google Scholar 

  17. Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K et al (2007) Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg 14(1):78–82

    Article  PubMed Central  PubMed  Google Scholar 

  18. Kumar SS (1992) Laparoscopic cholangiography: a new method and device. J Laparoendosc Surg 2(5):247–254

    Article  CAS  PubMed  Google Scholar 

  19. Sato N, Shibao K, Akiyama Y, Inoue Y, Mori Y, Minagawa N et al (2013) Routine intraoperative cholangiography during single-incision laparoscopic cholecystectomy: a review of 196 consecutive patients. J Gastrointest Surg. 17(4):668–674

    Article  PubMed  Google Scholar 

  20. Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180(1):101–125

    CAS  PubMed  Google Scholar 

  21. Curcillo PG 2nd, Wu AS, Podolsky ER, Graybeal C, Katkhouda N, Saenz A et al (2010) Single-port-access (SPA) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc 24(8):1854–1860

    Article  PubMed  Google Scholar 

  22. Raakow R, Jacob DA (2011) Single-incision cholecystectomy in about 200 patients. Minim Invasive Surg. 2011:915735

    PubMed Central  PubMed  Google Scholar 

  23. Navarra G, La Malfa G, Bartolotta G, Curro G (2008) The invisible cholecystectomy: a different way. Surg Endosc 22(9):2103

    Article  PubMed  Google Scholar 

  24. Weiss HG, Brunner W, Biebl MO, Schirnhofer J, Pimpl K, Mittermair C et al (2014) Wound complications in 1145 consecutive transumbilical single-incision laparoscopic procedures. Ann Surg 259(1):89–95

    Article  PubMed  Google Scholar 

  25. Waage A, Nilsson M (2006) Iatrogenic bile duct injury: a population-based study of 152 776 cholecystectomies in the Swedish inpatient registry. Arch Surg 141(12):1207–1213

    Article  PubMed  Google Scholar 

  26. Nuzzo G, Giuliante F, Giovannini I, Ardito F, D’Acapito F, Vellone M et al (2005) Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies. Arch Surg 140(10):986–992

    Article  PubMed  Google Scholar 

  27. Verbeek FP, Schaafsma BE, Tummers QR, van der Vorst JR, van der Made WJ, Baeten CI, et al (2014) Optimization of near-infrared fluorescence cholangiography for open and laparoscopic surgery. Surg Endosc 28(4):1076–1082

Download references

Disclosures

Norihiro Sato, Kazunori Shibao, Yasuhisa Mori, Aiichiro Higure, and Koji Yamaguchi have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Norihiro Sato.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sato, N., Shibao, K., Mori, Y. et al. Postoperative complications following single-incision laparoscopic cholecystectomy: a retrospective analysis in 360 consecutive patients. Surg Endosc 29, 708–713 (2015). https://doi.org/10.1007/s00464-014-3726-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3726-0

Keywords

Navigation