A Comparison of Three Port and Four Port laparoscopic Cholecystectomy
Abstract
INTRODUCTION: With new advances in the field of surgery, there have been made many amendments in the methods of laparoscopic cholecystectomy. Since the advent of laparoscopic cholecystectomy, the four port technique has been a standard option for surgeons but for the past few years the role of the fourth trocar has been debated and three port techniques is sought to take its place.
OBJECTIVE: This study is an experimental prospective study which has been carried out to compare and contrast four port and three port techniques in terms of patient outcomes such as pain, nausea, satisfaction, hospital stay and complications rate.
METHODOLOGY: Data was collected from seventy seven patients who underwent laparoscopic cholecystectomy. Convenient sampling was used and sample was stratified into two age groups. Postoperative pain, nausea, analgesic requirements and the number of days of hospital stay was assessed amongst the patient using the visual analogue scale. Post-OP complications were also assessed.
RESULTS: “Young adults†(20-44 years) were 40 in number while 30 patients fell under the “Older adults†group (45 years and above). In “younger adults†the pain score was 4.29 (SD: ± 1.62) for three port and 5.78 (SD: ± 1.21) for four port, mean nausea score was less for four port i.e. 1.33 (SD: ± 2.17) than for three port 2.32 (SD: ± 2.24), Mean postoperative stay for four port 2.00 days (SD: ± 0 .71) was slightly more than three port 1.58 days (SD: ± 0.76).
In the older age groups the mean pain scores were : 3.33 (SD: ± 1.92) and 5.13 (SD: ± 1.46) for three and four port techniques respectively, mean nausea score amongst the old patients was not much different for three port and four port i.e. 1.40 (SD: ±1.88) and 1.27 (SD: ±2.09), patient satisfaction for three port 9.33 (SD: ± 0.97) was a little higher than four port 8.00 (SD: ± 1.22), mean postoperative stay for 3 port patients was 1.2 days (SD: ± 0.41) and for the 4 port patients was 1.8 days (SD: ± 0.56).
CONCLUSION: Three-port had a significantly better outcome than four-port technique in terms of post surgical pain, hospital stay and patient satisfaction. There was no significant difference in the complications rate and nausea.
KEY WORDS: Laproscopy, cholecyctectomy, cholecystitis, biliary colic, cholelithiasis
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