Outcomes and complications of three-incision versus single-incision laparoscopic cholecystectomy: a systematic review and meta-analysis.

Authors

Mosab Said, Ahmad Alzyoud, Fadi Alkhawaja, Mohammad AlElaimat, Ahmad Yousef Alazzam

Published in

Updates in surgery. Jul 08, 2026. Epub Jul 08, 2026.

Abstract

Laparoscopic cholecystectomy (LC) is widely regarded as the gold-standard for the management and treatment of gallbladder disease. Traditionally, LC has been performed using multiple small incisions to allow placement of trocars and instruments. However, single-incision laparoscopic surgery has emerged as a potential alternative, purportedly offering cosmetic and recovery benefits, though the evidence for these advantages remains inconsistent in the literature.
Nine studies published between 2010 and 2019, enrolling a total of 1,884 patients, were eligible for inclusion. A systematic review and meta-analysis methodology was employed adhering to PRISMA guidelines. Outcomes included conversion to open or additional-port surgery, operative time, postoperative hospital stay, biliary complications, postoperative wound infection, port-site (umbilical) hernia, and postoperative pain. Sensitivity analysis were performed using the leave-one-out method and restricted to randomized controlled trials (RCT-only analysis).
There was no statistically significant difference between single-incision laparoscopic cholecystectomy (SILC) and three-incision laparoscopic cholecystectomy (TILC) in terms of conversion rate (OR 1.05, 95% CI 0.64-1.72; P = 0.84), postoperative hospital stay (MD - 0.05 days, 95% CI - 0.11 to 0.02; P = 0.14), wound infection (OR 1.35, 95% CI 0.58-3.16; P = 0.48), port-site umbilical hernia (OR 1.80, 95% CI 0.17-19.60; P = 0.63), biliary complications, or postoperative pain (MD - 0.07, 95% CI - 0.21 to 0.07; P = 0.32; I² = 24%). Operative time was significantly longer in the SILC group (MD + 17.45 min, 95% CI 8.28-26.62; P = 0.0002; I² = 97%).
In carefully selected low-risk patients undergoing elective laparoscopic cholecystectomy, SILC is technically feasible and is not associated with significantly higher rates of conversion, wound infection, biliary complications, port-site hernia, prolonged hospital stay, or pain compared with TILC. However, SILC is associated with a statistically significant increase in operative time. These findings support SILC as an acceptable alternative to TILC in elective, low-complexity settings at experienced centres. They should not be extrapolated to patients with acute cholecystitis, significant obesity, or prior abdominal surgery, for whom the evidence base remains insufficient. High-quality randomized controlled trials including these populations are warranted.

PMID:
42417939
Bibliographic data and abstract were imported from PubMed on 08 Jul 2026.

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