Three port versus conventional four port laparoscopic cholecystectomy: comparative study

Background: Modifications in the Laparoscopic Cholecystectomy (LC) technique is done by reducing the size and number of ports in an attempt to improve patient’s satisfaction and outcome. This study was conducted to asses and compare the safety, outcome and advantages of three-port and four-port laparoscopic cholecystectomy. 
Methods: This prospective study included 92 patients who were presented with symptomatic gall stone disease or gall bladder polyp more than 1 cm. Patients with obstructive jaundice and choledocholithiasis, carcinoma gall bladder were excluded from the study. Patients were grouped into two groups: three port and four port group, who underwent three-port and four-port laparoscopic cholecystectomy respectively. Outcomes of the both groups were assessed and compared in terms of operative time, intra-operative and post-operative variables including rate and nature of complications, conversion rates, post-operative pain, duration of hospital stay, return to work and cosmetic outcome. 
Results: Statistically significant difference was found between the two groups in terms of Visual Analogue Score for pain at 6 and 24 hours, analgesic requirement, duration of hospital stay and return to work; all being less in the three-port laparoscopic cholecystectomy group. Results of other variables were comparable in the two groups. 
Conclusions: Three-port laparoscopic cholecystectomy is safe and appears to be more cost effective than four-port laparoscopic cholecystectomy. If laparoscopic cholecystectomy is carried out by an experienced surgeon, it can be started with three ports, if needed, a fourth port can be inserted.