An "all 5-mm ports" versus conventional ports approach to laparoscopic cholecystectomy and Nissen fundoplication: a randomized clinical trial

Abstract

Background: Although needlescopic surgery may reduce postoperative pain, the use of 3-mm instruments is cumbersome and has not gained popularity. We have described an "all 5-mm ports" approach to laparoscopic cholecystectomy (LC) and Nissen fundoplication (LNF).

Methods: Selected patients were randomized to undergo LC or LNF using either the "all 5-mm ports" approach (group 1) or the conventional approach (group 2) that used two 10-mm ports and two or three 5-mm ports. The patients and investigator were blinded to the size of ports used.

Results: Forty patients (20 in each group) were randomized. The groups were comparable for age, sex, and type and duration of surgery. No significant reductions in analgesic requirements at 7 days or in pain scores at 4 and 24 hours postoperatively were detected with the "all 5-mm ports" approach. However, the cosmetic satisfaction scores with the body (P=0.029), incisions (P=0.015), and scars (P=0.023) 4 weeks after surgery were significantly higher in group 1.

Conclusions: The "all 5-mm ports" approach to LC and LNF in selected patients did not offer clear advantages over the conventional approach in terms of postoperative pain or analgesic requirements. Nevertheless, the former approach enjoyed a superior cosmetic outcome and patient acceptability.