Three port laparoscopic cholecystectomy with or without a marionette sling: A randomized controlled trial.

Objectives: To compare between the three-port cholecystectomy versus adding a marionette sling to the three-port
cholecystectomy.
Patients and Methods: We operated on 52 patients through a three-port (group T) cholecystectomy and operated on
another 52 patients through a three-port plus a marionette sling inserted percutaneously through the gallbladder fundus
(group M).
Results: All the preoperative demographic data for patients of both groups were comparable. In group T, operative
duration was 46±12 min versus 47±11 min for group M (nonsignificant differences). The rate of conversion to four-port
technique was (9.6%) in group T versus (1.9%) in group M (a statistically significant difference). Bile leakage occurred
in only one (1.9%) patient in group T versus seven (13.5%) patients in group M (a statistically significant difference).
Patients of group T were discharged within 15±2 h of the operation while patients of group M were discharged within
15±3 h. (a statistically nonsignificant difference). In group T, the amount of fluid discharged in patient’s drain was about
100±20 ml while in group M patient’s drain discharged about 150±50 ml of fluids per patient (a statistically significant
difference). The incidence of SSI (Surgical Site Infection) in group T was 5.8% (3/52 patients) but in group M the
incidence of SSI was much higher than that (17.3%, 9/52 patients). Infections were mainly at the third port (drain site).
Conclusion: Adding an extra marionette sling to the three-port cholecystectomy decreased the rate of conversion to fourport cholecystectomy but it was associated with an increased incidence of superficial SSI.