Comparative Analysis: 3 port Vs 4 Port in Laparoscopy Cholecystectomy

This case series reports outcomes of 26 patients who underwent laparoscopic cholecystectomy for cholelithiasis in 2023 at a single center. The objective was to evaluate the incidence of bile duct injury based on surgical technique—3-port versus 4-port approach—and to assess the influence of additional procedures and diagnoses on outcomes. A retrospective analysis was conducted on 26 patients who underwent laparoscopic cholecystectomy between January and December 2023. Patients were divided into two groups: 16 underwent the 3-port technique, and 10 underwent the 4-port technique. Data were collected on additional procedures, including adhesiolysis and intraoperative cholangiography (IOC), as well as coexisting diagnoses such as cholecystitis, liver disease, empyema of the gallbladder, and adhesions. Among the 26 patients, 16 (61.53%) had 3-port surgery, while 10 (38.46%) had 4-port surgery. Adhesiolysis was performed in 5 patients (19.23%), and IOC in 2 (7.69%). Diagnoses included cholecystitis (30.76%), liver disease (7.69%), empyema (3.84%), and adhesions (3.84%). Bile duct injury was suspected postoperatively in 5 patients: 4 (25%) from the 3-port group and 1 (10%) from the 4-port group. Among those with additional diagnoses, bile duct injury occurred in 3 patients (18.75%) in the 3-port group and 1 (10%) in the 4-port group. The 3-port technique was associated with a higher incidence of bile duct injury. Coexisting conditions, particularly cholecystitis and adhesions, appeared to contribute to this risk. Further studies with larger sample sizes are needed to validate these findings and investigate contributing factors.