A Study Warns: Use Caution With SILC
A Study Warns: Use Caution With SILC
Joseph M, Phillips MR, Farrell TM, Rupp CC
Ann Surg. 2012;256:1-6
The authors conducted a literature review aimed at determining the frequency of adverse events in patients undergoing single-incision laparoscopic cholecystectomy. Literature reports with 20 or more patients were included in the study, for a total of 45 studies and 2626 patients. The overall complication rate was 4.2% and included 19 bile duct injuries. The estimated reported frequency of bile duct injury was 0.72% (7.2/1000 patients). In comparison, the historic rate of bile duct injury during the era of open cholecystectomy is about 0.2%, and the rate for conventional laparoscopic cholecystectomy is about 0.4%-0.5%.
On the basis of current experience with cholecystectomy, the estimated rates of bile duct injury during single-incision surgery are higher than injury rates during laparoscopic surgery or the conventional open approach. The true injury rate for the new approach is likely to be higher than what was reported in this review because nearly all reports excluded patients with acute cholecystitis. Furthermore, the reported results in the literature are likely to be biased toward favorable outcomes. The authors suggested that randomized trials are necessary before widespread adoption of this new approach.
Abstract
Single Incision Laparoscopic Cholecystectomy Is Associated With a Higher Bile Duct Injury Rate: A Review and a Word of Caution
Joseph M, Phillips MR, Farrell TM, Rupp CC
Ann Surg. 2012;256:1-6
Summary
The authors conducted a literature review aimed at determining the frequency of adverse events in patients undergoing single-incision laparoscopic cholecystectomy. Literature reports with 20 or more patients were included in the study, for a total of 45 studies and 2626 patients. The overall complication rate was 4.2% and included 19 bile duct injuries. The estimated reported frequency of bile duct injury was 0.72% (7.2/1000 patients). In comparison, the historic rate of bile duct injury during the era of open cholecystectomy is about 0.2%, and the rate for conventional laparoscopic cholecystectomy is about 0.4%-0.5%.
Viewpoint
On the basis of current experience with cholecystectomy, the estimated rates of bile duct injury during single-incision surgery are higher than injury rates during laparoscopic surgery or the conventional open approach. The true injury rate for the new approach is likely to be higher than what was reported in this review because nearly all reports excluded patients with acute cholecystitis. Furthermore, the reported results in the literature are likely to be biased toward favorable outcomes. The authors suggested that randomized trials are necessary before widespread adoption of this new approach.
Abstract
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