Single-incision laparoscopic cholecystectomy in children: a retrospective comparison with traditional laparoscopic cholecystectomy.

PURPOSE: The natural progression of minimal access surgery is to perform the same technical operation with minimal or no evidence of scarring. In children, small case series of single-incision laparoscopic cholecystectomy suggests that the operation is feasible; however, no comparison has been made to traditional, multiport laparoscopic cholecystectomy in patient safety, outcomes, and cost.

METHODS: A retrospective review of consecutive single-incision laparoscopic cholecystectomies in children was performed from January 2009 to November 2010. Demographics and outcome measures were recorded, including operative time, operative costs, length of stay, need for intravenous analgesia, and operative complications. A concurrent group of pediatric patients undergoing traditional, multiport laparoscopic cholecystectomy was used for comparison.

RESULTS: A total of 69 pediatric laparoscopic cholecystectomies were performed from January 2009 to October 2010. Forty-two patients with a mean age of 14.7 years (range, 5.9-18.9 years) underwent attempted single-incision laparoscopic cholecystectomy, and 27 patients with a mean age of 15 years (range, 2.8-19.4 years) underwent multiport laparoscopic cholecystectomy. Mean operative time (68 vs 64.5 minutes; P, not significant [NS]), length of stay (1.45 vs 1.19 days; P, NS), and doses of intravenous analgesia (1.7 vs 2; P, NS) were not significantly different for patients undergoing single-incision or multiport laparoscopic cholecystectomy, respectively. Two patients (5%) undergoing the single-incision approach required 1 additional port be placed to complete the operation. In addition, there was no significant difference in operative costs between the single-incision and multiport approach ($7766 vs $8383; P, NS).

CONCLUSION: Single-incision laparoscopic cholecystectomy is safe and effective in the pediatric population. It can be performed with the same technical exposure and outcomes as multiport laparoscopy, with the added benefit of little to no scarring and no increase in cost.