Single-Incision Laparoscopic Cholecystectomy Versus Multi-incision Laparoscopic Cholecystectomy: A Meta-analysis of Randomized Clinical Trials

Background: Single-incision laparoscopic cholecystectomy (SILC) is theoretically supposed to be associated with better cosmetic results and less surgical-site pain than multi-incision laparoscopic cholesystectomy (MILC). So far, several relevant randomized controlled trials (RCTs) have been reported, but the results are conflicting. Materials and Methods: Meta-analysis was conducted with all the qualified RCTs comparing SILC with MILC. The databases include PubMed, EmBase, and the Cochrane Library, and the censor data were collected up to November 2011. The analyzed outcome variables included postoperative pain score, analgesia requirements, morbidity, conversion rate, operative time, postoperative hospital stay, and postoperative cosmetic score. Analyses were based on the intention-to-treat principle, if possible. All the calculations and statistical tests were performed using ReviewerManager version 5.1.2 software. Results: Nine trials with a total of 755 patients (SILC in 400 patients, MILC in 355 patients) were identified and analyzed. SILC resulted in significantly longer operative time (P = .005) and higher postoperative cosmetic score on Day 30 after operation (P < .00001). There was no statistically significant difference between the groups in terms of postoperative pain score, analgesia requirements, morbidity, conversion rate, and postoperative hospital stay. Conclusions: Based on the current meta-analysis, SILC appears to be as safe and effective as MILC to remove the gallbladder and results in a longer operative time and higher cosmetic satisfaction on Day 30 after surgery.