Suture-suspension single-incision laparoscopic cholecystectomy versus conventional multiport laparoscopic cholecystectomy: a single-center, prospective, randomized controlled clinical study.

Abstract

Purpose: Single-incision laparoscopic cholecystectomy (SILC) shows superior cosmetic outcomes but greater technical difficulty. This study aimed to compare the short-term outcomes of the suture-suspension SILC versus conventional conventional multiport laparoscopic cholecystectomy (CMLC) and to analyze the risk factors of difficult SILC.

Methods: From October 2023 to September 2024, 120 patients with symptomatic cholelithiasis were enrolled and randomly assigned to either the suture-suspension SILC group (60 patients) or the conventional CMLC group (60 patients). The primary outcome was operative time. Secondary outcomes included intra-operative blood loss, postoperative hospitalization duration, time to first flatus, 24-hour postoperative pain score, incidence of postoperative complications (bile leakage, hemorrhage, wound infection), and subjective satisfaction.

Results: Compared to the conventional CMLC, suture-suspension SILC showed no significant differences in operative time (P > 0.05) or intra-operative blood loss (P > 0.05). However, the time to first flatus (1.20 ± 0.443 days), duration of postoperative hospitalization (1.58 ± 0.889 days), and the 24-hour postoperative pain score (3.92 ± 1.225) in the suture-suspension SILC group were all significantly lower than those in the CMLC group (P ≤ 0.05). The subjective satisfaction score (3.98 ± 0.431 points) in the suture-suspension SILC group was significantly higher than that in the CMLC group (3.32 ± 0.469 points, P < 0.001). No postoperative complications occurred in either group. Thickened gallbladder wall, elevated white blood cell (WBC) count, and pericholecystic effusion were identified as factors associated with the operative time of SILC (P ≤ 0.05). A gallbladder wall thickness exceeding 4.375 mm was associated with an operative time longer than the average for the suture-suspension SILC procedure.

Conclusion: The suture-suspension method renders SILC short-term outcomes comparable to those of conventional CMLC. However, the choice of surgical technique should be made cautiously in cases of severe gallbladder inflammation.