الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallstone disease. It is associated with less postoperative pain, better cosmetic results, faster recovery, and earlier return to normal activity. The procedure is usually performed through four ports. A reduction in the number of ports has been suggested as a modification of standard technique with aim of reducing postoperative pain and improving cosmoses.The aim of the present study was to compare between the single incision multiport laparoendoscopic (SIMPLE) cholecystectomy and the two port laparoscopic cholecystectomy (TPLC) as regards feasibility, safety, postoperative pain, complications and patient satisfaction with the procedure.
In the present study, 148 patients were assessed for eligibility, the inclusion criteria were fulfilled in 80 patients. They were divided randomly into two equal groups using the closed envelope technique; the Single incision multiport laparoendoscopic cholecystectomy group (SIMPLE group= 40 patients) and the Two port laparoscopic cholecystectomy group (TPLC group=40 patients). There was no statistically significant difference between both study groups as regards the demographic data, the incidence of associated co-morbidities and the incidence of patients who had prior abdominal surgery.
In the present study, SIMPLE cholecystectomy was attempted in 40 patients and was successfully completed in 39 patients (97.5%). One patient was excluded from further analysis due to the addition of an extra trocar. On the other hand, TPLC was successfully completed in 40 patients (100%). The median total operative time in SIMPLE cholecystectomy group was statistically significantly longer than that in the TPLC group (60 Vs 47.5 minutes respectively; p<0.001). There was no statistically significant difference between both study groups as regards the incidence of dissection induced gall bladder perforation and bile/stone spillage encountered as well as the incidence of needle-induced gallbladder perforation with bile spillage. In the SIMPLE cholecystectomy group, the classical critical view of safety with its three components was achieved in 8 patients (20.5%), while in the TPLC group it was achieved in 10 patients (25%) with the difference being statistically insignificant (p=0.635).
Only one patient in either group developed wound infection. In the present study neither common bile duct injuries nor bile leaks were encountered in either study group. The overall 24-hours median pain score was statistically significantly lower in the SIMPLE cholecystectomy group (p<0.001). All patients in the present study were discharged on the morning of postoperative day one and there were two readmissions in the TPLC group because of deep vein thrombosis in one patient and a subhepatic collection that was successfully drained percutaneously in the other Throughtout the follow-up duration, the patient excluded from analysis in SIMPLE cholecystectomy group developed Port site hernia (PSH) 4 months postoperatively and hernioplasty was done. The difference in the median patient satisfaction score between both study groups was statistically significantly higher in the SIMPLE group (p=0.004