Lesson learned after 500 single access cholecystectomies in non selected patients

P. Bucher, S. Ostermann, F. Pugin, A. Carecchio, P. Morel

Objective

Single access surgery, and especially cholecystectomy, is now progressing since a decade aiming to decrease cosmetic and parietal trauma associated with conventional laparoscopic cholecystectomy. We here review our result through a series of 500 non selected consecutive cases of single access cholecystectomies.

Methods

Retro-pro review of 500 consecutive and non selected cases of single access cholecystectomies from 2008 to 2014. This review does not included the first cases performed during the learning curve and developing period of single access surgery for our team from 2006 and 2007. This review focus on peri- and short term post-operative results, aiming to evaluate safety and results of this progressing technique.

Results

Among these 500 cases, 65% presented symptomatic gallstone disease (biliary colic, history of cholecystitis or biliairy pancreatitis), 25% presented acute cholecystitis, 5% severe chronic cholecystitis and 5% stone migration. Median operative time was 53 minutes, while intra-operative cholangiography was successfully performed in 87%. Conversion to multiple port laparoscopy was needed in 13 cases (2.6%), mainly due to obesity or severe inflammation. No conversion was requested by peri-operative complications. No transfusion were needed. No bile leak were recorded post-operatively and no complication requiring re-operation were recorded. Morbidity was 0.6% (including only grade I and II Clavien-Dindo complication. Only one umbilical hernia was recorded with a median follow-up of 37months. Morbidity was null. In 13.6% of patients and additional surgery was associated (mainly umbilical hernia repair).

Conclusion

Single access cholecystectomy is a valid alternative to conventional laparoscopic cholecystectomy in non selected patients. When performed by experienced team it is safe and efficient. Moreover it is associated with excellent recovery and extremely high patient satisfaction.