Comparative Evaluation of Gall Bladder Retrieval from Epigastric vs Umbilical Port After Laparoscopic Cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy has now become gold standard treatment for gallstone diseases. Although few recent articles suggest that after laparoscopic cholecystectomy gall bladder (GB) retrieval from umbilical port is better, but the evidence is inconsistent. The objective of this study was to compare specimen retrieval from epigastric vs. umbilical port in terms of postoperative pain, time taken, and ease of retrieval. Methods: Total 200 patients aged 16-80 years were randomized by drawing lottery slips by a third person from a box containing 200 sealed envelopes (100 for each group). Those with acute cholecystitis, empyema, mucocele, suspected malignancy, and conversion to open and chronic analgesic users were excluded. Surgery was done by consultant surgeon under standard general anesthesia with four-port technique and GB was extracted either through epigastric or umbilical port as per draw. The difficulty in specimen retrieval was graded by operating surgeon on subjective linear scale and postoperative port site pain was assessed by resident blinded to intervention with Visual Analog Scale. Results: Both groups were well matched regarding age, sex, body mass index, and comorbidities. Mean time taken to retrieve in epigastric group was 36.76 ± 6.26 vs. 22.48 ± 5.76 seconds in umbilical group (P < .01). We observed easy retrieval via umbilical port compared to epigastric (score 2.72 ± 1.42 vs. 6.48 ± 1.32, P. 001). Epigastric group patients had Visual Analog Scale 6.56±0.768, 5.60 ± 1.225, 4.56 ± 1.325, and 2.72 ± 1.308 vs. 4.16 ± 1.214, 2.72 ± 1.275, 1.76 ± 1.234, and. 92±0.759 at 1, 6, 12, and 24 hours in umbilical group. The P value at different timings were. 001, thus indicating less pain in umbilical group. Conclusion: Umbilical port is better than epigastric port in terms of time taken for GB retrieval, ease of retrieval, and postoperative pain.

Keywords

• epigastric port
• laparoscopic cholecystectomy
• umbilical port
• visual analog scale