Comparison of Postoperative Port-Site Pain After Gallbladder Retrieval From Epigastric Versus Umbilical Port in Patients of Laparoscopic Cholecystectomy for Symptomatic Cholelithiasis: A Randomized Controlled Trial

Abstract

IntroductionGallbladder (GB) retrieval is an important cause of postoperative pain (POP) after laparoscopic cholecystectomy (LC). Retrieval is through the epigastric or umbilical port based on the surgeon's preference. There is limited evidence to support the superiority of one port over the other in terms of POP. This study was done to compare POP between epigastric and umbilical ports after GB retrieval in LC for symptomatic cholelithiasis. Material and methodsAll patients who underwent elective LC for symptomatic cholelithiasis were randomized for GB retrieval either through the umbilical (n = 15) or epigastric (n = 15) port. Postoperatively, the retrieval difficulty score by the operating surgeon, visual analog scale (VAS) scores for pain, and surgical site infection (SSI) by postoperative day (POD) 10 and 30 were assessed.

Port Site Morbidities Following the Extraction of the Gallbladder from the Umbilical Port in Comparison to the Epigastric Port in Laparoscopic Cholecystectomy: A Double-Blinded, Randomized Controlled Trial

“…Consistent with other randomized trials [8,11,12], our study showed a higher incidence of port site infections in the epigastric group. The umbilical port is usually visualized as a "dirty" port, considering its ignorance during bathing.…”

“…The only study that we could find that reported the methods of sample size calculation was by Siddique et al [5] and Jain et al [11]. Our sample size was calculated considering it to be a superiority trial, as previous studies reported mixed results, most favouring umbilical port sites and a few favouring epigastric port sites.…”

“…We followed the patient for post-operative port site pain at three-hour intervals initially for the first 12 hours. Hajong et al [9] followed up with patients at one, six, 12, and 24 hours after surgery, whereas Siddiqui et al [5] and Jain et al [11] followed up with patients at one, six, 12, 24, and 36 hours after surgery. We feel that the patient is still under the effects of anaesthetic agents when pain is assessed as early as an hour after surgery.…”

“…Both the umbilical and epigastric ports are used for gallbladder retrieval, depending on the surgeon's preference or local institutional guidelines. Various randomized controlled trials [5][6][7][8][9][10][11][12] have compared umbilical and epigastric sites for gallbladder extraction with mixed results, with some favouring umbilical and others epigastric port sites. Meta-analyses conducted by Sood et al [13], Mongelli et al [14], Kulkarni et al [15], and Hajibandeh et al [6] pointed out the heterogeneity of these individual trials and hence, the difficulty in deriving a concrete conclusion.…”