Three-Port versus four-port laparoscopic cholecystectomy: a propensity score–matched retrospective cohort study of operative safety and short-term outcomes
Emre Özoran1, Sinem Sağlam2, Emre Bozkurt31Department of General Surgery, Nişantaşı University School of Medicine, İstanbul, Türkiye2Department of General Surgery, HPB Clinic Coordinator Nurse, Acıbadem Altunizade Hospital, İstanbul, Türkiye
3Department of General Surgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Türkiye
INTRODUCTION: The four-port technique is standard for laparoscopic cholecystectomy, but robust comparisons with the three-port technique that account for baseline differences are limited. We assessed whether three-port cholecystectomy achieves operative safety and short-term outcomes comparable to those of the four-port technique, using propensity score matching to account for confounding by indication.
METHODS: We conducted a two-centre retrospective cohort study of 166 patients undergoing laparoscopic cholecystectomy (85 three-port, 81 four-port). The primary outcome was overall 30-day morbidity. Groups were compared before and after 1: 1 nearest-neighbour propensity score matching based on age, sex, body mass index, ASA score, and comorbidity. The study was reported in accordance with the STROBE guideline.
RESULTS: Patients selected for the four-port technique were older (median, 50 versus 42 years; p=0.003), had a higher body mass index (29 versus 26 kg/m²; p<0.001), and had higher rates of hypertension, cardiac disease, and anticoagulant use (all p<0.02). Operative time was longer with the four-port technique (44 versus 40 minutes; p=0.008); complications were rare in both groups, with no bile duct injury or mortality. Propensity score matching produced 54 well-balanced pairs (all SMD<0.10). In the matched cohort, operative time (40 versus 40 minutes; p=0.729) and length of stay (p=0.188) did not differ significantly. One patient in the four-port group required reoperation for bleeding; no conversions or mortality occurred in either group.
DISCUSSION AND CONCLUSION: After adjustment for baseline risk, no statistically detectable differences in operative or shortterm clinical outcomes were observed between the three-port and four-port techniques. The three-port technique could be used in selected patients with a low level of procedural difficulty.
Keywords: Cholelithiasis, laparoscopic cholecystectomy, propensity score matching, reduced-port surgery, surgical outcomes, three-port technique
Manuscript Language: English