A comparative study of postoperative port-site pain after gallbladder retrieval from umbilical versus epigastric ports in laparoscopic cholecystectomy

Abstract

Introduction: Gall bladder (GB) retrieval is an important cause for postoperative pain after laparoscopic cholecystectomy (LC). GB is usually extracted either from the epigastric or the umbilical port and there are limited data to decide the superiority of one over other in terms of postoperative pain. This study was designed to determine whether GB retrieval from the umbilical port was associated with less pain as compared to epigastric port in adult patients undergoing four ports elective LC. Material and Methods: A total of 100 patients took part in the study and were randomly allocated into 2 groups. Postoperatively, port-site pain score was assessed at 1, 6, 12, and 24 h by visual analog scale (VAS) score both for the epigastric and umbilical ports in all the patients and the collected data were analyzed by using SPSS version 22. Result: VAS score for postoperative pain at epigastric port at 1, 6, 12, and 24 h found to be higher as compared to umbilical port (6.640 ± 1.494 vs. 5.500 ± 1.176, 6.620 ± 1.549 vs. 5.320 ± 1.188, 6.100 ± 1.549 vs. 4.660 ± 1.232, 5.250 ± 1.459 vs. 3.970 ± 1.274, respectively) which was statistically significant ( P value 0.001). But the time taken for retrieval of GB was significantly longer in the umbilical group (4.94 ± 1.56 vs. 3.24 ± 1.29). Conclusion: Umbilical port is better as compared to epigastric port for GB retrieval in patient undergoing elective four port LC in terms of postoperative port-site pain but it takes relatively longer time for the extraction.

Gallbladder Retrieval From Epigastric Versus Umbilical Port in Laparoscopic Cholecystectomy: A PRISMA-Compliant Meta-Analysis

“…Patients' comorbidities were reported in the study of Li et al 21 only (glycuresis, asthma, chronic, and acute cholecystitis) and resulted comparable between groups. In terms of gallbladder pathology, only Siddiqui et al 16 and Hajong et al 22 reported a total number of gallbladder polyps of 5/105 and 6/104 in epigastric and umbilical extraction site, respectively (P = .757). A port enlargement was described in the study of Kaya et al 19 only (6/60 vs 11/60 in the epigastric and umbilical extraction site, respectively), while Siddiqui et al 16 enlarged routinely the epigastric port to extract the gallbladder, and Hajong et al 22 excluded patients requiring a port dilatation.…”

“…In terms of gallbladder pathology, only Siddiqui et al 16 and Hajong et al 22 reported a total number of gallbladder polyps of 5/105 and 6/104 in epigastric and umbilical extraction site, respectively (P = .757). A port enlargement was described in the study of Kaya et al 19 only (6/60 vs 11/60 in the epigastric and umbilical extraction site, respectively), while Siddiqui et al 16 enlarged routinely the epigastric port to extract the gallbladder, and Hajong et al 22 excluded patients requiring a port dilatation. Finally, the abdominal fascia was sutured in the study of Siddiqui et al 16 and Shakya et al 20 at the umbilical port site, while Kaya et al 19 performed the closure in all port site >10 mm.…”

“…All included studies provided data about age, gender, and postoperative pain on VAS 24 hours after surgery. [16][17][18][19][20][21][22] The studies of Siddiqui et al 16 and Hajong et al 22 provided also results in terms of pain on VAS at 1, 6, and 12 hours after surgery. Data about the incidence of hernia were reported by Kaya et al 19 and Li et al, 21 while the rate of infections was reported by Kaya et al, 19 Shakya et al, 20 and Li et al 21 Finally, Siddiqui et al 16 and Li et al 21 reported the total length of the cholecystectomies, while Ahmad et al, 17 Bashir et al, 18 Shakya et al, 20 and Hajong et al 22 reported the time to retrieve the gallbladder only.…”

“…Finally, the abdominal fascia was sutured in the study of Siddiqui et al 16 and Shakya et al 20 at the umbilical port site, while Kaya et al 19 performed the closure in all port site >10 mm. 16 Ahmad Et al 17 Bashir Et al 18 Kaya Et al 19 Shakya Et al 20 Li Et al 21 Hajong Et al 22 Type of study The risk of bias of the selected studies is reported in Figure 2. According to the Study Quality Assessment of Controlled Intervention Studies of NHLBI, 11 the study of Siddiqui et al, 16 Kaya et al, 19 Shakya et al, 20 Li et al, 20 and Hajong et al 22 were categorized "good," and studies of Ahmad et al 17 and Bashir et al 18 were categorized "fair."…”

“…16 Ahmad Et al 17 Bashir Et al 18 Kaya Et al 19 Shakya Et al 20 Li Et al 21 Hajong Et al 22 Type of study The risk of bias of the selected studies is reported in Figure 2. According to the Study Quality Assessment of Controlled Intervention Studies of NHLBI, 11 the study of Siddiqui et al, 16 Kaya et al, 19 Shakya et al, 20 Li et al, 20 and Hajong et al 22 were categorized "good," and studies of Ahmad et al 17 and Bashir et al 18 were categorized "fair." According to the GRADE approach, due to limitations in study quality (lack of blinding rated down by 1 and imprecision), the overall quality of evidence of this metaanalysis was judged "moderate" to "low.…”