Retrieval of Gall Bladder Through Umbilical Port versus Epigastric Port During Laparoscopic Cholecystectomy: A Prospective Interventional Study

Introduction: Cholelithiasis affects 10-15% of the population and the majority of these cases are asymptomatic, often detected incidentally through abdominal sonography. Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstones. The choice of retrieval method for the gall bladder, either from the umbilical or epigastric port, lies in the hands of the operating surgeon. No study has recommended the superiority of extraction from either port; however, the incidence of port-site hernia and infection is more common with the umbilical port. Aim: The aim of the present study was to compare the retrieval of the gall bladder from either port concerning postoperative pain, retrieval time and the incidences of port-site infection and hernia. Materials and Methods: The present prospective interventional study was conducted in the Department of Surgery at AIIMS, Nagpur, India, over one and a half years, involving 88 patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis, with 44 patients assigned to both the umbilical and epigastric retrieval ports. Pain scores were compared using the Visual Analog Scale (VAS) at 12, 24 and 48 hours postsurgery. Patients were subsequently followed up for portsite infection and port-site hernia. Categorical variables were expressed as percentages or proportions. The chi-square test was applied for categorical variables and the independent t-test was used for continuous variables. Results: The study initially enrolled 110 patients; however, ten were lost to follow-up and 12 were excluded due to intraoperative biliary spillage and conversion to open surgery. This resulted in 44 patients in each arm. The mean age of the sample population was 47.11±15.62 years for the epigastric port group and 48.86±14.62 years for the umbilical port group. The female-to-male ratio for the epigastric extraction port was 1.32:1, while for the umbilical extraction port, it was 2.44:1. The mean VAS score postoperatively from either port was found to be statistically significant at 48 hours. The mean time for gall bladder retrieval was 6.36±4.44 minutes for the epigastric port, compared to 7.91±6.32 minutes for the umbilical port, which was not statistically significant. There were no reported cases of port-site infection or hernia. Conclusion: The present study concluded that the retrieval of the gall bladder from either port does not have a significant impact on retrieval time, postoperative pain, surgical site infections, or port-site hernias.