A Study on Gallbladder Retrieval via Epigastria V/S Supraumbilical port in Laparoscopic Cholecystectomy

The operation of laparoscopic cholecystectomy is still evolving with time as the size and number of ports are reducing day by day. This comparative study was done to compare the extraction of gallbladder through epigastria/subxiphoid port versus supraumbilical port in laparoscopic cholecystectomy in terms of postoperative pain on first day, gallbladder retrieval time, extendibility of the incision and port-site infection This is an observational comparative study for duration of one and half year at NMCTH. Total 148 patients were included in the study. Patients underwent standard four port laparoscopic cholecystectomy and were followed for one week after discharge. Postoperative pain at interval of 0, 6, 12 and 24 hours were recorded by Visual Analogue Scale (VAS). Performa were filled for all participants and collected data was analyzed in SPSS 16. For the analysis, paired t-test, independent t-test and chi-square test were used. Ethical approval was taken from Institutional Review Committee (IRC) of NMCTH. The mean VAS scores for pain were higher at the exit port from which the GB was retrieved as compared to non-exit port at all hours of assessment and was statistically significant (P = 0.001). Higher VAS scores were observed for the epigastria port as compared to the umbilical port group at all measured time intervals which was statistically significant (P = 0.001). Mean time taken for retrieval of GB from epigastria port was longer as compared to the umbilical port (7.31±1.87 vs. 6.93±2.25 minutes) but was statistically insignificant (P = 0.270). Port site infection (PSI) were seen in 5 (3.38%) patients. PSI and bile spillage were statistically insignificant (P = 0.139). The chances of port site extension for GB retrieval increased with stones measuring greater than 10 mm (P = 0.0001). The retrieval of the GB from the umbilical port is superior to that from the epigastria port in terms of decreased postoperative pain. The chances of port extension increased with stones larger than 10mm. The mean time taken for GB retrieval and PSI are comparable in both ports.