Open Access Research article

Three-port versus four-port laparoscopic cholecystectomy in acute and chronic cholecystitis

Dhafir Al-Azawi12*, Nariman Houssein3, Abu Bakir Rayis2, Donal McMahon4 and Dermot J Hehir2

Author Affiliations

1 Department of surgery, Royal College of Surgeons in Ireland, Dublin Ireland

2 Department of surgery, Tullamore regional Hospital, Tullamore, Co. Offally, Ireland

3 School of Diagnostic imaging, University College Dublin, Dublin, Ireland

4 School of Mathematical Sciences, University College Dublin, Dublin, Ireland

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BMC Surgery 2007, 7:8  doi:10.1186/1471-2482-7-8

Published: 13 June 2007



Several modifications have been introduced to laparoscopic cholecystectomy (LC). The three-port technique has been practiced on a limited scale. Our aim was to compare the three-port and four-port LC in acute (AC) and chronic cholecystitis (CC).


The medical records of 495 patients who underwent LC between September 1999 and September 2003 were reviewed. Variables such as complications, operating time, conversion to open procedure, hospital stay, and analgesia requirements were compared.


Two hundred and eighty-three patients underwent three-port LC and 212 patients underwent four-port LC. In total, 163 (32.9%) patients were diagnosed with AC and 332 (67.1%) with CC by histology. There was no statistical difference between the three and four-port groups in terms of complications, conversion to open procedure (p = 0.6), and operating time (p = 0.4). Patients who underwent three-port LC required less opiate analgesia (pethidine) than those who underwent four-port LC (p = 0.0001). The hospital stay was found to be related to the amount of opiates consumed (p = 0.0001) and was significantly shorter in the three-port LC group (p = 0.005).


Three-port LC is a safe procedure for AC and CC in expert hands. The procedure offers considerable advantages over the traditional four-port technique in the reduction of analgesia requirements and length of hospital stay.