Is the trocar through which the gallbladder is removed during cholecystectomy important for potential complications?

Abstract

Objective: Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallstone disease and complications can develop at trocar sites following laparoscopic cholecystectomy. This study aims to evaluate the impact of extracting the gallbladder through either the umbilical or epigastric ports during laparoscopic cholecystectomy on the complications observed after gallbladder extraction. Methods: Symptomatic cholelithiasis patients who had four port laparoscopic cholecystectomy included to the study. Individuals were divided into two groups based on gallbladder removal site: umbilical or epigastric. Medical records were reviewed for post-surgical complications within 30 days and incisional hernias within one year. The age, gender, operation duration, BMI and the largest stone dimentions of the patients were also noted. Results: A total of 112 patients were included in the study, with 45 patients in the umbilical group and 67 patients in the epigastric group. No significant differences were observed in age, gender, body mass index and stone dimentions between groups. Port site hernia and port site infection developed more frequently but not significantly in umblical group. When examined the stone dimention and BMI based on the presence of a port site hernia and port site infection, BMI and stone dimention were significantly higher in port site infection and hernia patients. Conclusion: Using umbilical port for removing gallbladder, carried a higher risk of infection and hernia development. Additionally, regardless of which trocar is used, patients with a high BMI and large stone dimensions have a higher risk of port site infection and hernia. Patients should be informed about these risks during the preoperative period.

Keywords

• Gallstone
• Laparoscopic cholecystectomy
• Port-site hernia
• Port-site infection

Ethical Statement

This study protocol was reviewed and approved by non-invasive clinical studies ethics committee of Istanbul Training and Research Hospital, approval number 57.

References

1. Reitano E, de’Angelis N, Schembari E, et al. Learning curve for laparoscopic cholecystectomy has not been defined: A systematic review. ANZ J Surg. 2021;91:E554-E560.
2. Raj A, Singh S, Raj A, Tajdar Y. A Randomized Controlled Trial Evaluating Postoperative Port Site Infections Among Patients Undergoing Laparoscopic Cholecystectomy Either via Umbilical or Epigastric Port. Cureus. 2023;15:e48709.
3. Vashisht A, Routh D, Kandari AK, Rao PP. To Compare Gall Bladder Retrieval from Epigastric versus Umbilical Port in Laparoscopic Cholecystectomy: A Randomized Controlled Study. Medical Journal of Dr. D.Y. Patil Vidyapeeth. 2023;16:216-221
4. Kulkarni AA, Sharma G, Deo KB, Jain T. Umbilical port versus epigastric port for gallbladder extraction in laparoscopic cholecystectomy: A systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Surgeon. 2022;20:e26-e35.
5. Kaya C, Bozkurt E, Yazici P. The impact of gallbladder retrieval from an epigastric vs. umbilical port on trocar-site complications A prospective randomized study. Ann Ital Chir. 2017;88:326-329.
6. Nguyen NT, Reavis KM, Hinojosa MW, Smith BR, Wilson SE. Laparoscopic trans‑umbilical cholecystectomy without visible abdominal scars. J Gastrointest Surg 2009;13:1125‑1128.
7. Philipp SR, Miedema BW, Thaler K. Single‑incision laparoscopic cholecystectomy using conventional instruments: Early experience in comparison with the gold standard. J Am Coll Surg. 2009;209:632-637.
8. Sasmal PK, Mishra TS, Rath S, Meher S, Mohapatra D. Port site infection in laparoscopic surgery: a review of its management. World journal of clinical cases. 2015;3:864e71.

9. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection. Centers for disease control and prevention (CDC) Hospital infection control Practices Advisory committee. Am J Inf Contr. 1999;27:97e132.
10. Brockmann JG, Kocher T, Senninger NJ, Schurmann GM. Complications due to gallstones lost during laparoscopic cholecystectomy. Surg Endosc. 2002;16:1226e32.
11. Jabbari Nooghabi A, Hassanpour M, Jangjoo A. Consequences of lost gallstones during laparoscopic cholecystectomy: a review article. Surg Laparosc Endosc Percutaneous Tech. 2016;26:183e92.
12. La Regina D, Mongelli F, Cafarotti S, et al. Use of retrieval bag in the prevention of wound infection in elective laparoscopic cholecystectomy: is it evidence-based? A meta-analysis. BMC Surg. 2018;18:102.
13. Usman J, Janjua A, Ahmed K. The frequency of port‑site infection in laparoscopic cholecystectomies. Pak J Med Health Sci. 2016;10:1324-1326.
14. Shindholimath VV, Seenu V, Parshad R, Chaudhry R, Kumar A. Factors influencing wound infection following laparoscopic cholecystectomy. Trop Gastroenterol. 2003;24:90-92.
15. Jan WA, Ali IS, Shah NA, Ghani A, Khan M, Khan AS. The frequency of port‑site infection in laparoscopic cholecystectomies. Med J Dr. D.Y. Patil Vidyapeeth. 2008;22:66-70.
16. Hamzaoglu I, Baca B, Böler DE, Polat E, Ozer Y. Is umbilical flora responsible for wound infection after laparoscopic surgery? Surg Laparosc Endosc Percutan Tech. 2004;14:263-267.
17. Colizza S, Rossi S, Picardi B, et al. Surgical infections after laparoscopic cholecystectomy: Ceftriaxone vs ceftazidime antibiotic prophylaxis. A prospective study. Chir Ital 2004;56:397-402.
18. Tocchi A, Lepre L, Costa G, Liotta G, Mazzoni G, Maggiolini F. The need for antibiotic prophylaxis in elective laparoscopic cholecystectomy: A prospective randomized study. Arch Surg. 2000;135:67-70.
19. Ahmad MS, Javed MU, Qureshi ARZ, Dar UF, Imtiaz U, Ayuob A. Gallbladder retrieval in three ports laparoscopic cholecystectomy: Umbilical port versus subxiphoid port. Pak J Med and Health Sci. 2015;9:769-771.
20. Nofal MN, Yousef AJ, Hamdan FF, Oudat AH. Characteristics of Trocar Site Hernia after Laparoscopic Cholecystectomy. Sci Rep. 2020;10:2868.
21. Bowrey DJ, Blom D, Crookes PF, et al. Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication. Surg Endosc. 2001;15:663e6.
22. Coda A, Bossotti M, Ferri F, et al. Incisional hernia and fascial defect following laparoscopic surgery. Surg Laparosc Endosc Percutaneous Tech. 1999;9:348e52.
23. Memon JM, Memon MR, Arija D, Bozdar AG, Talpur MM. Retrieval of gallbladder through epigastric port as compared to umbilical port after laparoscopic cholecystectomy. Pak J Pharm Sci. 2014;27:2165e8.
24. Nofal MN, Yousef AJ, Hamdan FF, Oudat AH. Characteristics of trocar site hernia after laparoscopic cholecystectomy. Sci Rep. 2020;10:2868.