Fewer Ports Cut Opioid Use and Length of Stay in Elective Laparoscopic Cholecystectomy

Abstract

Background: Postoperative pain is one of the most common reasons for prolonged hospital stay with opioid analgesia the mainstay of treatment.

Objectives: The purpose of this study was to determine whether the degree of abdominal trauma, reflected by the number and sizes of ports used in elective laparoscopic cholecystectomy, correlated against opioid analgesia requirements and length of stay.

Methods: A retrospective clinical audit was undertaken of 144 patients who underwent elective laparoscopic cholecystectomies with 3-port (12/5/5) and 4-port approaches (12/5/5/5 and 12/10/5/5). In the reduced port cases, liver retraction was achieved using a suction retractor, removing the requirement for a fourth port. The number of ports and total cross-sectional area of all ports were compared against the procedure time, length of stay, and opioid analgesia required.

Results: The smaller total cross-sectional area associated with the 3-port approach (12/5/5, 277.25 mm2) resulted in significantly lower total oral morphine equivalent daily dose required compared to 12/10/5/5 (453.96 mm2) and 12/5/5/5 (327.52 mm2) approaches, being 30.7 mg and 21.0 mg less, respectively (p < 0.001). The 3-port approach had a mean length of stay 0.8 days which was significantly shorter compared to both 4-port approaches (p = 0.001, length of stay of 1.1 and 1.2 days for 12/5/5/5 and 12/10/5/5, respectively). Laparoscopic cholecystectomy patients in the study hospitals routinely stayed overnight.

Conclusions: The absolute number of ports used in elective laparoscopic cholecystectomies appears to play an important role in postoperative recovery. In particular, 3-port configurations may result in less postoperative pain without the burden of an increase in length of stay, morbidity, or mortality rates.

Keywords: Enhanced Recovery After Surgery (ERAS); Laparoscopic cholecystectomy; Liver retractor; Reduced port surgery.