A Randomized Controlled Trial Evaluating Postoperative Port Site Infections Among Patients Undergoing Laparoscopic Cholecystectomy Either via Umbilical or Epigastric Port.

BACKGROUND AND OBJECTIVES:  Laparoscopic cholecystectomy (LC) is a keyhole surgical procedure considered a gold standard treatment for benign gallbladder (GB) diseases. GB retrieval is done per the surgeon's choice through an umbilical or epigastric port. However, postoperative port site infection (PSI) and pain were major complications of this technique. The study aimed to compare the postoperative PSI between epigastric and umbilical ports among patients undergoing LC.

METHODS:  A prospective randomized controlled trial was conducted among 50 patients who underwent LC for benign GB disease at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, for 6 months. Participants were randomized into epigastric port (n=25) and umbilical port (n=25). Postoperatively, PSI on a postoperative day (POD) of 10 and 30, retrieval difficulty score, Postoperative pain (POP) using a visual analog scale (VAS), and port site scar appearance after 6 months were assessed.

RESULTS:  This study divided 50 LC patients into epigastric and umbilical ports (n=25). Among them, 31 were females (62%), 19 males (38%), and mean ages of 43.5 ± 10.7 and 40.7 ± 12.6 years were observed for the epigastric and umbilical ports; group age was similar (p=0.37). The gender distribution was similar between groups (p=0.9 for males, p=0.7 for females). The epigastric port displayed a mean body mass index (BMI) of 22.3 ± 1.01, while the umbilical port had a significantly higher mean BMI of 23.7 ± 1.10 (p=0.04). Patients with symptomatic cholelithiasis as the primary reason for surgery were common in both groups (p=0.2 for GB stones, p=0.4 for GB polyps). The mean hospital stays and surgical duration were similar (p=0.7 and 0.99). Epigastric ports had 8% postoperative PSI on POD 10 (vs. 12%, p=0.07) and 0% on POD 30 (vs. 4%, p=1.0), compared to umbilical ports. Umbilical port patients were more satisfied with scar appearance (92% vs. 76%, p=0.11) and less dissatisfied (8% vs. 24%, p=0.02) 6 months post-surgery. Compared to the umbilical port, patients with epigastric ports had significantly higher VAS pain scores at multiple postoperative time points (p-values <0.001 to 0.03). It was also harder to retrieve epigastric port GB (p=0.01).

CONCLUSION:  The current study highlights the importance of port site selection among patients who underwent LC, as it can notably impact postoperative outcomes. While the umbilical port may be associated with lower PSI rates and better cosmetic outcomes, GB retrieval through the epigastric port may result in lower postoperative port site pain. Surgeons should carefully consider these factors when choosing the port site for LC procedures. Further research, including larger multicenter trials, is needed to validate and expand upon these results, ultimately enhancing patient care in GB surgery.