Single-incision vs three-incision laparoscopic cholecystectomy for complicated and uncomplicated acute cholecystitis

Table 1 Patient characteristics and pathology n (%)

	Complicated acute cholecystitis		P value	Uncomplicated acute cholecystitis		P value
	SILC group (n = 23)	3ILC group (n = 27)		SILC group (n = 39)	3ILC group (n = 19)
Age (yr)	51.2 ± 15.3	58.0 ± 17.3	0.147	49.1 ± 13.9	54.6 ± 14.5	0.167
Sex (male/female)	7/16	10/17	0.623	24/15	9/10	0.306
Body mass index (kg/m2)	25.24 ± 3.36	26.36 ± 3.59	0.272	25.01 ± 2.67	26.99 ± 4.35	0.081
Modified APACHE II score (points)			0.318			0.595
0-5, low risk	21 (91.3)	22 (81.5)		36 (92.3)	17 (89.5)
6-9, intermediate risk	2 (8.7)	5 (18.5)		2 (5.1)	2 (10.5)
10-11, high risk	0	0		1 (2.6)	0
Previous abdominal surgery	7	3	0.089	6	5	0.319
Previous biliary symptoms	12	10	0.283	30	11	0.135
Duration of acute symptoms > 72 h	14	14	0.522	34	13	0.087
Pathology			0.985
Gangrene	15 (65.2)	18 (66.7)		-	-
Empyema	6 (26.1)	7 (25.9)		-	-
Hydrops	2 (8.7)	2 (7.4)		-	-
Acute inflammation	-	-		39 (100)	19 (100)

SILC: Single-incision laparoscopic cholecystectomy; 3ILC: Three-incision laparoscopic cholecystectomy.

Table 2 Operative modifications and results n (%)

	Complicated acute cholecystitis		P value	Uncomplicated acute cholecystitis		P value
	SILC group (n = 23)	3ILC group (n = 27)		SILC group (n = 39)	3ILC group (n = 19)
Preoperative ERCP	0	3	0.099	0	1	0.148
Preoperative ERCP and EST	2	0	0.118	3	4	0.143
Intraoperative cholangiography	1	0	0.274	5	5	0.202
Operative time (min)	119.8 ± 38.8	124.3 ± 32.1	0.660	100.9 ± 42.1	118.4 ± 45.5	0.154
Estimated blood loss (mL)	43.2 ± 29.8	31.0 ± 26.6	0.156	24.2 ± 31.5	29.5 ± 29.9	0.548
Pethidine dose (mg/kg)	0.624 ± 0.505	0.535 ± 0.740	0.632	0.618 ± 0.485	0.549 ± 0.427	0.601
Postoperative length of hospital stay (d)	3.5 ± 1.1	4.6 ± 1.3	< 0.010	2.9 ± 1.1	3.7 ± 1.4	< 0.050
Total length of hospital stay (d)	6.0 ± 3.6	5.8 ± 3.1	0.814	4.1 ± 1.9	6.4 ± 4.7	0.053
Conversion
Overall	8 (34.8)	10 (37.0)	0.869	7 (17.9)	4 (21.1)	0.777
2ILC	4	-		3	-
3ILC	2	-		1	-
4ILC (standard LC)	2	10		3	4
OC	0	0		0	0

SILC: Single-incision laparoscopic cholecystectomy; 2ILC: Two-incision laparoscopic cholecystectomy; 3ILC: Three-incision laparoscopic cholecystectomy; 4ILC: Four-incision laparoscopic cholecystectomy; OC: Open cholecystectomy; ERCP: Endoscopic retrograde cholangiopancreatography; EST: Endoscopic sphincterotomy.

Table 3 Postoperative body temperature

Maximum body temperature (°C)	Complicated acute cholecystitis		P value	Uncomplicated acute cholecystitis		P value
	SILC group	3ILC group		SILC group	3ILC group
Post-op day 1	37.73 ± 0.57	38.03 ± 0.66	0.096	37.41 ± 0.56	37.80 ± 0.72	< 0.050
Post-op day 2	37.38 ± 0.59	37.58 ± 0.46	0.180	37.10 ± 0.43	37.57 ± 0.54	< 0.010
Post-op day 3	37.12 ± 0.49	37.30 ± 0.49	0.215	37.04 ± 0.45	37.04 ± 0.56	0.990
Post-op day 4	37.18 ± 0.44	37.19 ± 0.45	0.974	36.88 ± 0.41	36.86 ± 0.33	0.915

Including only patients who were still hospitalized. SILC: Single-incision laparoscopic cholecystectomy; 3ILC: Three-incision laparoscopic cholecystectomy; post-op: Postoperative.

Table 4 Complications n (%)

Complications	Complicated acute cholecystitis		P value	Uncomplicated acute cholecystitis		P value
	SILC group (n = 23)	3ILC group (n = 27)		SILC group (n = 39)	3ILC group (n = 19)
Overalll	3 (13.0)	3 (11.1)	0.834	3 (7.7)	2 (10.5)	0.718
Grade I	1 (4.3)1	1 (3.7)2		2 (5.1)3	0
Grade II	1 (4.3)4	0		1 (2.6)5	1 (5.3)6
Grade IIIa	1 (4.3)7	2 (7.4)8		0	0
Grade IIIb	0	0		0	1 (5.3)9
Grade IVa, IVb, V	0	0		0	0

¹Pleural effusion and atelectasis;

²Pleural effusion;

³One was pleural effusion and atelectasis; the other was pleural effusion;

⁴Refractory diarrhea;

⁵Infected subhepatic collection;

⁶Relapsed cholangitis with bacteremia;

⁷Infected subhepatic collection and pleural effusion;

⁸One was infected subhepatic collection; the other was retained bile duct stones;

⁹Retained bile duct stones. SILC: Single-incision laparoscopic cholecystectomy; 3ILC: Three-incision laparoscopic cholecystectomy.

Table 5 Overall comparison of complicated and uncomplicated acute cholecystitis groups

	Complicated acute cholecystitis (n = 50)	Uncomplicated acute cholecystitis (n = 58)	P value
Age (yr)	54.9 ± 16.6	50.9 ± 14.2	0.184
Sex (male/female)	33/17	33/25	0.333
Modified APACHE II score			0.320
0-5, low risk	43 (86.0)	53 (91.4)
6-9, intermediate risk	7 (14.0)	4 (6.9)
10-11, high risk	0	1 (1.7)
Operative time (min)	122.2 ± 35.0	106.6 ± 43.6	< 0.050
Estimated blood loss (mL)	36.1 ± 28.3	26.0 ± 30.8	0.092
Pethidine dose (mg/kg)	0.577 ± 0.633	0.595 ± 0.464	0.867
Postoperative length of hospital stay (d)	4.1 ± 1.3	3.2 ± 1.2	< 0.001
Total length of hospital stay (d)	5.9 ± 3.3	4.8 ± 3.3	0.098
Conversion	18 (36.0)	11 (19.0)	< 0.050
Complications	6 (12.0)	5 (8.6)	0.563

Data are expressed as absolute numbers (percentage) or mean ± SD.