Seven RCTs (611 patients, range 40 to 197) were included in the review. All studies had adequate randomisation procedures and clearly reported withdrawals and drop-outs. One study was double blind, four studies were single blind and two studies did not report on blinding. Three of the studies were undertaken in multiple centres. All studies were considered of high quality.
Cosmetic score: Compared to traditional laparoscopy, laparoendoscopic single site cholecystectomy was associated with a significantly improved cosmetic score at one week (SMD 0.48, 95% CI 0.24 to 0.73; two RCTs; Ι²=0%), two weeks (SMD 0.87, 95% CI 0.61 to 1.13; two RCTs; Ι²=0%) and one month after surgery (SMD 0.88, 95% CI 0.62 to 1.14; two RCTs; Ι²=0%).
Physical quality of life score: Compared to traditional laparoscopy, laparoendoscopic single site cholecystectomy was associated with a significantly reduced physical quality of life score at day three (SMD -0.28, 95% CI -0.52 to -0.04; two RCTs; Ι²=0%), one week (SMD -0.31, 95% CI -0.55 to -0.06; two RCTs; Ι²=0%) and two weeks after surgery (SMD -0.30, 95% CI -0.55 to -0.05; two RCTs; Ι²=0%). At other time cutoff points (one day, five days and one month postoperatively) there was no evidence of significant differences between groups.
Other outcomes: There was no evidence of a significant difference between types of cholecystectomy for the visual analogue scale pain score at either 12 hours after surgery (two RCTs; Ι²=90%) or 24 hours after surgery (four RCTs; Ι²=92%). There was no evidence of a significant difference between groups for the perioperative complication rate (five RCTs; Ι²=0%), intraoperative blood loss (two RCTs; Ι²=0%), postoperative hospital stay (three RCTs; Ι²=0%) and operating time (five RCTs; Ι²=92%).
The authors noted that they were not able to identify clinical heterogeneity between trials in analyses that indicated substantial heterogeneity.