Comparison of 3 Port vs 4 Port Laparoscopic Cholecystectomy for Gallstone Disease

Mahrukh  Shafiq; Rohit  Kumar; Aun  Ali; Muhammad Khurram  Zia; Mansoor  Iqbal; Yousuf  Lakdawala

doi:10.54112/bcsrj.v6i6.1901

Authors

Mahrukh Shafiq Department of General Surgery, FRPMC PAF Hospital Karachi, Pakistan
Rohit Kumar Department of General Surgery, PNS Shifa Hospital Karachi, Pakistan
Aun Ali Department of General Surgery, FRPMC PAF Hospital Karachi, Pakistan
Muhammad Khurram Zia Department of General Surgery, Liaquat College of Medicine and Dentistry and Darul Sehat Hospital Karachi, Pakistan
Mansoor Iqbal Department of General Surgery, FRPMC PAF Hospital Karachi, Pakistan
Yousuf Lakdawala Department of General Surgery, FRPMC PAF Hospital Karachi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.1901

Keywords:

Cholecystectomy, Laparoscopic; Gallstones; Pain Measurement; Postoperative Complications

Abstract

Laparoscopic cholecystectomy (LC) is the gold standard for treating symptomatic gallstones. Conventionally performed with four ports, the three-port modification has been proposed to reduce surgical trauma, postoperative pain, and recovery time. However, evidence comparing the safety and outcomes of three-port versus four-port LC in the Pakistani population remains limited. Objective: To evaluate and compare the clinical outcomes and perioperative risks of three-port LC with four-port LC. Methods: This randomised comparative study was conducted at F.R.P.M.C. PAF Hospital, Karachi, from 1 August 2023 to 1 July 2024, following ethical approval. A total of 60 patients aged 18–60 years of both genders, classified as ASA I or II, and scheduled for elective LC were recruited through non-probability consecutive sampling. Patients were randomised into two groups: three-port LC and four-port LC. Intraoperative complications, conversion to open surgery, length of hospital stay, postoperative pain (assessed by a standardised pain score), and recovery time were compared. Statistical analysis was performed using appropriate parametric and non-parametric tests, with p<0.05 considered significant. Results: Intraoperative complications were lower in the three-port group compared with the four-port group (17% vs. 40%, p=0.09). Conversion to open surgery occurred in 27% of three-port and 40% of four-port cases (p=0.255). The mean hospital stay was significantly shorter in the three-port group (2.8±0.6 days) than in the four-port group (3.5±0.7 days) (p<0.0001). Postoperative pain scores were also significantly lower in the three-port group (5.7±0.9) compared to the four-port group (6.5±0.9) (p=0.001). Furthermore, recovery time was faster in the three-port group (14.9±1.4 days) compared with the four-port group (17.2±1.5 days) (p<0.0001). Conclusion: Three-port LC is a safe and effective alternative to conventional four-port LC, offering shorter hospitalisation, reduced postoperative pain, faster recovery, and enhanced patient satisfaction, without increasing intraoperative risks.

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