Comparison of Three-Port Cholecystectomy with Four-Port Cholecystectomy among Patients Undergoing Laparoscopic Cholecystectomy at a Tertiary Care Center in Haryana – A Randomized Control Study

Background: Laparoscopic cholecystectomy (LC) is the standard treatment for gallstone disease. While the conventional four-port LC provides excellent access and safety, the three-port modification may offer benefits such as less postoperative pain, shorter operative time, and improved cosmetic outcomes. This study aimed to compare intraoperative and postoperative outcomes between three-port and four-port LC. Methods: A prospective randomized clinical study was conducted on 148 patients with symptomatic cholelithiasis and cholecystitis at Bhagat Phool Singh Government Medical College for Women, Sonepat, from January 2023 to July 2024. Patients aged 18–70 years were randomized equally to undergo either three-port or four-port LC. Operative parameters, complications, pain (VAS at 6 h, 24 h, and day 7), analgesic requirements, hospital stay, drain use, and cosmetic satisfaction were analyzed using SPSS v24.0, with p<0.05 considered significant. Results: Both groups were demographically comparable. Mean operative time was significantly shorter in the three-port group (48.6±23.9 vs 56.2±20.0 min; p<0.01). Conversion to four-port occurred in 10.8% of cases. Complication rates were similar (bile spillage 14–15%, liver bleeding 5–9%, gallbladder perforation 7–8%; p>0.05). Mean hospital stay (3.5 vs 3.3 days) and analgesic use (1.7 doses) were comparable. Pain scores were lower in the three-port group on day 7 (p<0.05), and cosmetic satisfaction was significantly higher (87.8% vs 67.6%; p<0.01). Conclusion: Three-port LC is a safe and effective alternative to the four-port technique, offering shorter operative time, reduced late postoperative pain, and superior cosmetic satisfaction without increasing complications or hospital stay.