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Introduction: An increasing body of evidence is being published about single-incision laparoscopic cholecystectomy (SILC), but there are no well-powered trials with an adequate evaluation of post-operative pain. This randomized trial compares SILC against four-port laparoscopic cholecystectomy (LC) with post-operative pain as the primary endpoint., Methods: Hundred patients were randomized to either SILC (n = 50) or LC (n = 50). Exclusion criteria were (1) Acute cholecystitis; (2) ASA 3 or above; (3) Bleeding disorders; and (4) Previous open upper abdominal surgery. Patients and post-operative assessors were blinded to the procedure performed. The site and severity of pain were compared at 4 h, 24 h, 14 days and 6 months post-procedure using the visual analog scale; non-inferiority was assumed when the lower boundary of the 95% confidence interval of the difference was above -1 and superiority when p ≤ 0.05., Results: The study arms were demographically similar. At 24 h post-procedure, SILC was associated with less pain at extra-umbilical sites (rest: p = 0.004; movement: p = 0.008). Pain data were inconclusive at 24 h at the umbilical site on movement; SILC was otherwise non-inferior for pain at all other points. Operating duration was longer in SILC (79.46 vs 58.88 min, p = 0.003). 8% of patients in each arm suffered complications (p = 1.000). Re-intervention rates, analgesic use, return to function, and patient satisfaction did not differ significantly., Conclusions: SILC has improved short-term pain outcomes compared to LC and is not inferior in both short-term and long-term pain outcomes. The operating time is longer, but remains feasible in routine surgical practice.

Background: Single-incision laparoscopic cholecystectomy (SILC) has been increasingly performed recently. Although it seems plausible that SILC will be associated with less pain compared to standard 4-port laparoscopic cholecystectomy (LC), there is currently no conclusive comparative study on the postoperative pain issues of SILC against LC., Methods: In this retrospective, case-control study, 30 patients who had SILC over a 6-month period were compared with a matched (sex, age group, race) group of 30 patients who underwent LC. Verbal pain score (VPS) on postoperative days (POD) 1, 2, 3, and 5; pain sites; analgesic requirement; and number of days (NoD) required to return to normal activities were compared., Results: There were 4 (13%) acute cholecystitis cases in each group. Average VPS on POD 1, 2, 3, and 5 of SILC and (LC) cholecystectomy patients were 4.53 (5.14) (P=0.09), 3.43 (3.83) (P=0.36), 2.07 (2.52) (P=0.25), and 1.13 (1.24) (P=0.69), respectively. In the SILC group, 26 patients (87%) had umbilical pain, whereas in the LC group, 25 patients (83%) had similar symptoms. Epigastric pain was experienced by 5 patients in the two groups, and RHC pain was experienced by 1 patient in the SILC group (3%) and 2 patients in the LC group (7%). The SILC and the LC patients required 4.00 and 4.90 days (P=0.09) of paracetamol, respectively, to control pain. The NoD required before return to normal activity in the SILC and LC groups was 5.97 days and 7.79 days (P=0.008), respectively., Conclusions: There was no statistically significant difference in postoperative pain, pain site and analgesia requirement; however, patients who underwent SILC returned to their normal activity 1.8 days earlier than the LC patients. Larger RCTs are needed to compare postoperative outcomes between SILC and LC.