J Korean Surg Soc.  2013 Oct;85(4):149-153. 10.4174/jkss.2013.85.4.149.

Effect of laparoscopic cholecystectomy techniques on postoperative pain: a prospective randomized study

Affiliations
  • 1Department of General Surgery, Selcuk University Faculty of Medicine, Konya, Turkey. hyilmazmd@hotmail.com
  • 2Department of Anesthesiology and Reanimation, Selcuk University Faculty of Medicine, Konya, Turkey.

Abstract

PURPOSE
Minimally invasive surgical technics have benefits such as decreased pain, reduced surgical trauma, and increased potential to perform as day case surgery, and cost benefit. The primary aim of this prospective, randomized, controlled study was to compare the effects of single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) procedures regarding postoperative pain.
METHODS
Ninety adult patients undergoing elective laparoscopic cholecystectomy were included in the study. Patients were randomized to either SILC or CLC. Patient characteristics, postoperative abdominal and shoulder pain scores, rescue analgesic use, and intraoperative and early postoperative complications were recorded.
RESULTS
A total of 83 patients completed the study. Patient characteristics, postoperative abdominal and shoulder pain scores and rescue analgesic requirement were similar between each group except with the lower abdominal pain score in CLC group at 30th minute (P = 0.04). Wound infection was seen in 1 patient in each group. Nausea occurred in 13 of 43 patients (30%) in the SILC group and 8 of 40 patients (20%) in the CLC group (P > 0.05). Despite ondansetron treatment, 6 patients in SILC group and 7 patients in CLC group vomited (P > 0.05).
CONCLUSION
In conclusion, in patients undergoing laparoscopic surgery, SILC or CLC techniques does not influence the postoperative pain and analgesic medication requirements. Our results also suggest that all laparoscopy patients suffer moderate and/or severe abdominal pain and nearly half of these patients also suffer from some form of shoulder pain.

Keyword

Laparoscopic cholecystectomy; Postoperative pain

MeSH Terms

Abdominal Pain
Adult
Cholecystectomy, Laparoscopic
Cost-Benefit Analysis
Humans
Laparoscopy
Nausea
Ondansetron
Pain, Postoperative
Postoperative Complications
Prospective Studies
Shoulder Pain
Wound Infection
Ondansetron

Reference

1. Downs SH, Black NA, Devlin HB, Royston CM, Russell RC. Systematic review of the effectiveness and safety of laparoscopic cholecystectomy. Ann R Coll Surg Engl. 1996; 78(3 Pt II):241–323.
2. Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg. 2001; 167:84–96.
3. Kucuk C, Kadiogullari N, Canoler O, Savli S. A placebo-controlled comparison of bupivacaine and ropivacaine instillation for preventing postoperative pain after laparoscopic cholecystectomy. Surg Today. 2007; 37:396–400.
4. Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg. 1995; 81:379–384.
5. Lum YW, House MG, Hayanga AJ, Schweitzer M. Postcholecystectomy syndrome in the laparoscopic era. J Laparoendosc Adv Surg Tech A. 2006; 16:482–485.
6. Tsai AY, Selzer DJ. Single-port laparoscopic surgery. Adv Surg. 2010; 44:1–27.
7. Curcillo PG 2nd, Wu AS, Podolsky ER, Graybeal C, Katkhouda N, Saenz A, et al. Single-port-access (SPA) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc. 2010; 24:1854–1860.
8. Hernandez JM, Morton CA, Ross S, Albrink M, Rosemurgy AS. Laparoendoscopic single site cholecystectomy: the first 100 patients. Am Surg. 2009; 75:681–685.
9. Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L, Kinross J, Paraskeva P. Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surg Endosc. 2012; 26:1205–1213.
10. Trastulli S, Cirocchi R, Desiderio J, Guarino S, Santoro A, Parisi A, et al. Systematic review and meta-analysis of randomized clinical trials comparing single-incision versus conventional laparoscopic cholecystectomy. Br J Surg. 2013; 100:191–208.
11. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I. One-wound laparoscopic cholecystectomy. Br J Surg. 1997; 84:695.
12. Pfluke JM, Parker M, Stauffer JA, Paetau AA, Bowers SP, Asbun HJ, et al. Laparoscopic surgery performed through a single incision: a systematic review of the current literature. J Am Coll Surg. 2011; 212:113–118.
13. Garg P, Thakur JD, Garg M, Menon GR. Single-incision laparoscopic cholecystectomy vs. conventional laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Gastrointest Surg. 2012; 16:1618–1628.
14. Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N, Mavridou P, et al. Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc. 2010; 24:1842–1848.
15. Sinan H, Demirbas S, Ozer MT, Sucullu I, Akyol M. Single-incision laparoscopic cholecystectomy versus laparoscopic cholecystectomy: a prospective randomized study. Surg Laparosc Endosc Percutan Tech. 2012; 22:12–16.
16. Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. Anesthesiology. 2006; 104:835–846.
17. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2004; 100:1573–1581.
18. Asakuma M, Hayashi M, Komeda K, Shimizu T, Hirokawa F, Miyamoto Y, et al. Impact of single-port cholecystectomy on postoperative pain. Br J Surg. 2011; 98:991–995.
19. Lai EC, Yang GP, Tang CN, Yih PC, Chan OC, Li MK. Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg. 2011; 202:254–258.
20. Saad S, Strassel V, Sauerland S. Randomized clinical trial of single-port, minilaparoscopic and conventional laparoscopic cholecystectomy. Br J Surg. 2013; 100:339–349.
21. Luna RA, Nogueira DB, Varela PS, Rodrigues Neto, Norton MJ, Ribeiro Ldo C, et al. A prospective, randomized comparison of pain, inflammatory response, and short-term outcomes between single port and laparoscopic cholecystectomy. Surg Endosc. 2013; 27:1254–1259.
22. Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. Br J Surg. 2000; 87:273–284.
23. Berberoğlu M, Dilek ON, Ercan F, Kati I, Ozmen M. The effect of CO2 insufflation rate on the postlaparoscopic shoulder pain. J Laparoendosc Adv Surg Tech A. 1998; 8:273–277.
24. Mouton WG, Bessell JR, Otten KT, Maddern GJ. Pain after laparoscopy. Surg Endosc. 1999; 13:445–448.
25. Gurusamy KS, Samraj K, Davidson BR. Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2009; (2):CD006930.
26. Cao ZG, Cai W, Qin MF, Zhao HZ, Yue P, Li Y. Randomized clinical trial of single-incision versus conventional laparoscopic cholecystectomy: short-term operative outcomes. Surg Laparosc Endosc Percutan Tech. 2011; 21:311–313.
Full Text Links
  • JKSS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr