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Single Incision Laparoscopic Cholecystectomy Is Associated With a Higher Bile Duct Injury Rate: A Review and a Word of Caution

Joseph, Mark MD; Phillips, Michael R. MD; Farrell, Timothy M. MD; Rupp, Christopher C. MD

doi: 10.1097/SLA.0b013e3182583fde

Objective: To compare the incidence of bile duct injuries during single incision laparoscopic cholecystectomy (SILC) in relation to the accepted historic rate of 0.4% to 0.5% for standard laparoscopic cholecystectomy (SLC).

Background: Technically, SILC is more challenging than SLC. The role and benefit of SILC in patient care has yet to be defined. Bile duct injuries have been reported in several series of SILC.

Method: A comprehensive database search of MEDLINE, EMBASE, CINAHL, and PubMed Central was performed to generate all reported cases of SILC to present. The search was limited to reports of 20 or more patients based on current literature of existing SILC learning curves. Data were analyzed using the Student t test and χ2 analyses where appropriate.

Results: A total of 76 candidate studies were identified; 45 studies met inclusion criteria for an aggregate total of 2626 patients. Most SILCs were performed in the absence of acute cholecystitis (90.6%). The aggregate complication rate was 4.2%, and complications were graded according to the Dindo-Clavien Classification System. Nineteen bile duct injuries were identified for a SILC-associated bile duct injury rate of 0.72%.

Conclusions: There seems to be an increase in the rate of bile duct injuries during SILC when compared with historic rates during SLC. Because most SILCs are performed in optimal conditions, such as lack of acute inflammation, we urge caution in applying this technique to inflamed gallbladder pathology. Controlled trials are needed before conclusions are made regarding safety of SILC.

Single incision laparoscopic cholecystectomy (SILC) creates several operative challenges that are poorly defined to date. Several studies have reported bile duct injuries during SILC and our results suggest an increase in the bile duct injury rate with SILC.

From the Department of Surgery, University of North Carolina, Chapel Hill, NC.

Reprints: Christopher C. Rupp, MD, University of North Carolina, 4035 Burnett Womack Bldg, CB 7081, Chapel Hill, NC 27599. E-mail:

Disclosure: The authors declare that they have nothing to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.