This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Systematic review and meta‐analysis of randomized clinical trials comparing single‐incision versus conventional laparoscopic cholecystectomy. BJS 2013; 100: 191-208.
Published: 12th November 2012
Authors: S. Trastulli, R. Cirocchi, J. Desiderio, S. Guarino, A. Santoro, A. Parisi et al.
Background
Single‐incision laparoscopic cholecystectomy (SILC) may offer advantages over conventional laparoscopic cholecystectomy (LC).
Method
MEDLINE, Embase, PubMed, CINAHL, Cochrane Central Register of Controlled Trials and the Cochrane Library were searched for randomized clinical trials on SILC versus LC until May 2012. Odds ratio (OR) and weight mean difference (WMD) were calculated with 95 per cent confidence intervals (c.i.) based on intention‐to‐treat analysis.
Results
Thirteen randomized clinical trials included a total of 923 procedures. SILC had a higher procedure failure rate than LC (OR 8·16, 95 per cent c.i. 3·42 to 19·45; P < 0·001), required a longer operating time (WMD 16·55, 95 per cent c.i. 9·95 to 23·15 min; P < 0·001) and was associated with greater intraoperative blood loss (WMD 1·58, 95% of c.i. 0·44 to 2·71 ml; P = 0·007). There were no differences between the two approaches in rate of conversion to open surgery, length of hospital stay, postoperative pain, adverse events, wound infections or port‐site hernias. Better cosmetic outcomes were demonstrated in favour of SILC as measured by Body Image Scale questionnaire (WMD − 0·97, 95% of c.i. − 1·51 to − 0·43; P < 0·001) and Cosmesis score (WMD − 2·46, 95% of c.i. − 2·95 to − 1·97; P < 0·001), but this was based on comparison with procedures in which multiple and often large ports (10 mm) were used.
Conclusion
SILC has a higher procedure failure rate with more blood loss and takes longer than LC. No trial was adequately powered to assess safety. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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