A COMPARATIVE STUDY OF THREE PORT VERSUS FOUR PORT LAPAROSCOPIC CHOLECYSTECTOMY Comparative of three Versus

: INTRODUCTION: Four port laparoscopic cholecystectomy has been a standard procedure for removal of gall bladder. Each additional port gives more morbidity to the patient. Research continues to devise procedures which are more patient friendly. Reducing the number of ports has been postulated to be superior in terms of requirement of analgesics, hospital stay, cosmesis and cost. AIMS AND OBJECTIVES: Comparison of three port and four port laparoscopic cholecystectomy in terms of Operating time, Safety of the procedure, Need for the additional ports, Postoperative pain, Hospital stay and Cosmesis. MATERIALS AND METHODS: 100 patients with symptomatic gall stone disease were managed by laparoscopic cholecystectomy. In 50 patients the procedure was performed using three ports and in another 50 patients traditional four ports were used. In patients with three port laparoscopic cholecystectomy 5mm port along anterior axillary line was omitted which is usually used for retracting the fundus of gall bladder. RESULTS AND DISCUSSION: There was no difference between the two groups with respect to success rate, operative time, and hospital stay. However we conclude that three-port laparoscopic cholecystectomy group is preferable as there is fewer requirements of analgesics, is less expensive and is cosmetically better than four port laparoscopic cholecystectomy. port group (2.91±1.20) p value =0.02. There was no statistically significant difference between the two groups with respect to post-operative complications. However 1 patient in either group had fever >100 0 F due to thrombophlebitis and 1 patient had one port site infection which was managed by applying antiseptic dressing twice a day. The mean hospital stay in three port group was 2.08±0.27 days while as in four port group it was 2.10±0.30 days (P>0.05). These results were comparable with the results reported by Dion Y M et al. 15 Cosmesis was assessed by the size of the surgical scars and the number of scars. Patients in both the groups were operated laparoscopically, however in three port group there was one less scar than four port group. Average(range) scar size was 4 mm scar (3.5–5.5 mm) at 5 mm port and 11 mm scar (9–11 mm) at the epigastric port area, the umbilical scar was not seen. There were no port site hernias or any other delayed complications. patients in three port group were more satisfied with cosmetic results as they have one scar less than the other group. These results were consistent with the earlier reports. 6,7 No deaths were reported in our study. Bile duct injury probably is the most important issue in a comparison of the two groups. None of the patients in our study had bile duct injury. The operative field was quite clear and comparable to that in standard four ports cases. In some cases of three port group, the liver and gall bladder hindered the operative field and consumed slightly more time (Average 5-10 minutes). The three-port technique is as safe as the standard four-port laparoscopic cholecystectomy.