Estudio prospectivo aleatorizado comparativo entre colecistectomía laparoscópica versus colecistectomía por puerto único en régimen ambulatorio / A randomised prospective comparative study between laparoscopic cholecystectomy and single port cholecystectomy in a major outpatient surgery unit

Introducción: El objetivo de este estudio es comparar la colecistectomía laparoscópica (CL) con la realizada a través de una incisión única umbilical (SILC) en régimen de cirugía mayor ambulatoria (CMA).Material y métodos De octubre 2009 a junio 2011 se aleatorizaron prospectivamente 50 pacientes con colelitiasis sintomática; a 26 se les realizó SILC y a 24 CL en CMA. Se analizó el dolor postoperatorio, requerimientos de analgesia, presencia de náuseas y/o vómitos, tiempo operatorio, complicaciones, tasa de éxito de ambulatorización y resultados estéticos. Resultados No hubo diferencias en cuanto al dolor postoperatorio, la analgesia de rescate, náuseas y/o vómitos y tiempo operatorio (SILC 54 ± 21 min, CL 48,5 ± 17 min, p = 0,29). Hubo un caso de morbilidad en el grupo SILC que requirió reintervención. Se completó el procedimiento ambulatoriamente en el 77% de pacientes del grupo SILC y en el 83% del grupo CL. Seis pacientes del grupo SILC (23%) y 4 del grupo CL (17%) permanecieron ingresados más de 24 h (p = 0,58). Los resultados estéticos fueron valorados subjetivamente como muy bueno en el grupo SILC y bueno en el grupo CL. Conclusión La colecistectomía SILC es factible y segura comparándola con colecistectomía laparoscópica en pacientes seleccionados y obtiene resultados similares al aplicarla en CMA. Se requieren estudios más amplios para determinar los beneficios reales de este abordaje antes de recomendarlo como técnica rutinaria. Con mayor experiencia de los equipos quirúrgicos y mayor concienciación de los pacientes posiblemente aumente el número de candidatos a colecistectomía ambulatoria (AU)

Introduction: The aim of this study is to compare laparoscopic cholecystectomy (LC) with that performed using single umbilical incision laparoscopic surgery (SILS) in a major outpatient surgery (MOS) unit. Material and methods: A total of 50 patients with symptomatic cholelithiasis were prospectively randomised between October 2009 and June 2011, with 26 of them subjected to SILS, and 24 to CL. The variables analysed were, postoperative pain, analgesia requirements, presence of nausea/vomiting, operation time, complications, outpatient success rate, and aesthetic results. Results: There were no differences as regards postoperative pain, analgesia rescue, nausea/vomiting, or operation time (SILS 54 21 min, CL 48.5 17 min, P = .29). There was one case of morbidity in the SILS group which required further surgery. The outpatient surgical procedure was completed in 77% of patients of the SILS group, and in 83% of the CL group. Six patients (23%) from the SILS group, and 4 (17%) from the CL group remained in the unit for more than 24 h (P = .58). The aesthetic results were subjectively assessed as ‘‘very good’’ in the SILS group, and ‘‘good’’ in the CL group. Conclusion: SILS cholecystectomy is feasible and safe when comparing it with laparoscopiccholecystectomy in selected patients, and obtains similar results when performed in a MOS unit. Larger studies are needed to determine the real benefits of this approach beforere commending it as a routine technique. With more experienced surgical teams and greater awareness of the patients could possibly increase the number of candidates for outpatient cholecystectomy (AU)

[A randomised prospective comparative study between laparoscopic cholecystectomy and single port cholecystectomy in a major outpatient surgery unit]. / Estudio prospectivo aleatorizado comparativo entre colecistectomía laparoscópica versus colecistectomía por puerto único en régimen ambulatorio.

INTRODUCTION: The aim of this study is to compare laparoscopic cholecystectomy (LC) with that performed using single umbilical incision laparoscopic surgery (SILS) in a major outpatient surgery (MOS) unit. MATERIAL AND METHODS: A total of 50 patients with symptomatic cholelithiasis were prospectively randomised between October 2009 and June 2011, with 26 of them subjected to SILS, and 24 to CL. The variables analysed were, postoperative pain, analgesia requirements, presence of nausea/vomiting, operation time, complications, outpatient success rate, and aesthetic results. RESULTS: There were no differences as regards postoperative pain, analgesia rescue, nausea/vomiting, or operation time (SILS 54 ± 21 min, CL 48.5 ± 17 min, P=.29). There was one case of morbidity in the SILS group which required further surgery. The outpatient surgical procedure was completed in 77% of patients of the SILS group, and in 83% of the CL group. Six patients (23%) from the SILS group, and 4 (17%) from the CL group remained in the unit for more than 24h (P=.58). The aesthetic results were subjectively assessed as "very good" in the SILS group, and "good" in the CL group. CONCLUSION: SILS cholecystectomy is feasible and safe when comparing it with laparoscopic cholecystectomy in selected patients, and obtains similar results when performed in a MOS unit. Larger studies are needed to determine the real benefits of this approach before recommending it as a routine technique. With more experienced surgical teams and greater awareness of the patients could possibly increase the number of candidates for outpatient cholecystectomy.