Single-Port-Cholezystektomie versus Multi-Port-Cholezystektomie: Eine Kohortenstudie mit 222 Patienten

The aim of this study was to compare single-port access (SPA) cholecystectomy with standard laparoscopic technique (LC) concerning duration of the operation, complications, learning curve, late postoperative quality of life (QoL) and the incidence of incisional hernias. Between June 2009 and December 2011 122 SPA cholecystectomies were performed in our hospital. Simultaneously 310 patients were operated in LC-technique. In this group (LC) 100 patients met the same criteria defined for SPA-surgery. The two groups (SPA versus LC) were compared by multivariable regressions analysis. Endpoints of this study were QoL after 6 months by the EQ-5D-5L-questionnaire and the incidence of incisional hernia one year after surgery. Additionally operative time, hospital stay and perioperative complications were measured and compared. The median follow-up was 9.2 months (3-25 months). The patients in the SPA group were younger and more often female. The operation time was in group SPA with 73 min (35-136 min) significantly longer as in group LC with 60 minutes (33-190 min; p<0.001). In 8/122 (6.5%) of SPA-patients additional trocars were used. A conversion to open cholecystectomy was not necessary in SPA patients. The conversion rate in LC group to open cholecystectomy was 2% (2/100). The peri- and postoperative complications and incisional hernia (5.5%) were the same in both groups. QoL was significantly better in the SPA group in terms of mobility (p = 0.002), usual activity (p=0.036) and overall anxiety (p = 0.026). SPA cholecystectomy is safe although the operation is significantly longer. No differences in terms of major complications or the incidence of incisional hernia were seen after one year. QoL, was significantly better in patients operated in SPA technique.