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

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.