Colecistectomia laparoscopica per port únic versus quatre ports en un programa de cirurgia major ambulatòria. Estudi prospectiu aleatoritzat a doble cec

Identificador:  TDX:2677

Handle: https://hdl.handle.net/20.500.11797/TDX2677

Autores:  Subirana Magdaleno, Helena

Resumen:
BACKGROUND: Single-incision laparoscopic cholecystectomy (SILC) is increasingly being used as minimally invasive surgery, with potential benefits over four-port laparoscopic cholecystectomy (LC) in terms of reduced postoperative pain and faster recovery. The aim of this study is to compare SILC to four-port cholecystectomy (LC) in an outpatient surgery program. METHODS: Single-institution randomized double-blind controlled trial. Seventy-three patients with symptomatic cholelithiasis were randomised to either SILC (n=37) or LC (n=36). Exclusion criteria: BMI>35, laparoscopic contraindications, acute cholecystitis, choledocholithiasis, malignancies or anti-inflammatory allergies. Main endpoint: postoperative pain. Secondary endpoints: surgical time, procedural difficulty, adverse events, additional ports used and conversions, success of the outpatient process, hospital stay, return to work or usual activity, aesthetic satisfaction, satisfaction degree, quality of life and incidence of incisional hernia. RESULTS: Postoperative analgesic requirements were lower in the SILC group (with significant differences on the 7th day). Return to work was significantly sooner and cosmetic scores were significantly higher in the SILC group. In the surgeon’s opinion the SILC procedure was more difficult to perform. Operative time, surgical complications, postoperative pain, success of the ambulatory process, return to normal activity, quality of life scores and trocar-site hernia were similar for both procedures. CONCLUSIONS: SILC has significant advantages over LC in terms of late postoperative requirements of analgesics, cosmetic results and return to work time, but it is harder to implement for surgeons. Improved outpatient surgical outcomes were not demonstrated.