Single Incision Laparoscopic Cholecystectomy Is Associated With a Higher Bile Duct Injury Rate

Abstract

There seems to be an increase in the rate of bile duct injuries during SILC when compared with historic rates during SLC. Because most SILCs are performed in optimal conditions, such as lack of acute inflammation, we urge caution in applying this technique to inflamed gallbladder pathology. Controlled trials are needed before conclusions are made regarding safety of SILC.

Cholecystectomy: evolution of laparoscopic approach

“…М. Joseph и соавт. (2012), проанализировав 2625 ХЭ из ЕЛД, пришли к заключению, что совокупная частота ос-ложнений, классифицированных по шкале тяжести хирургических осложнений Dindo-Clavien [78], со-ставила 4,2%, а частота повреждений магистраль-ных желчных путей -0,72% [114].…”

Safety of single-incision cholecystectomy

“…Cholecystectomy is regarded as safe because it avoids bile duct injuries, which remain a surgical risk in laparoscopy. A recent review [2] that included all published studies (not only randomized trials, as in the Arezzo et al review) showed that singleincision cholecystectomy can be associated with an increased risk of bile duct injury and was it gave a clear word of caution. In contrast, the review by Arezzo et al found no increased risk with the single-incision approach.…”

“…In the lack of proven safety (due to the lack of power) or superiority in terms of postoperative outcomes [2,4], one cannot consider single-incision surgery as evidence-based. Only future properly sized randomized controlled trials will demonstrate (or not) that this approach is really safe and will become the preferred approach for cholecystectomy in daily practice.…”

Exclusion criteria for assuring safety of single-incision laparoscopic cholecystectomy

“…In some institutions favoring SILC over conventional multiport laparoscopic cholecystectomy (CLC), incidence of SILC reached 50% among all the LC procedures (4,5). In contrast, SILC has potential disadvantages compared to CLC in terms of longer operative time (6), increased cost for specialized laparoscopic instruments (7), a higher bile duct injury rate (8), and occurrence of umbilical hernia (3,9). In order to safely adopt SILC in clinical practice, we need strict criteria for indication of SILC, which have not been indicated clearly even in the guideline of LC by the Society of American Gastrointestinal and Endoscopic Surgeons (10).…”