Vol. 7, Issue 1, Part A (2025)

Introduction: Laparoscopic cholecystectomy has revolutionized gallbladder disease treatment since its introduction in 1987. Despite its advantages over open surgery, postoperative pain remains a significant concern, often requiring overnight hospitalization. The extraction of the gallbladder, either through the umbilical or epigastric port, is a crucial terminal step that can influence postoperative port site pain. This study aimed to evaluate and compare postoperative port site pain following laparoscopic cholecystectomy using umbilical versus epigastric port for gallbladder retrieval.
Methods: This prospective and retrospective observational study included 100 patients undergoing laparoscopic cholecystectomy at a tertiary care hospital. Patients were randomly divided into Group U (umbilical port retrieval, n=50) and Group E (Epigastric port retrieval, n=50). Standard four-port technique was employed, with gallbladder extraction in an endobag. Postoperative pain was assessed using a Visual Analog Scale (VAS) at 1, 6, 12, 24, and 48 hours. Secondary outcomes included difficulty in extraction, operative time, hospital stay, and need for rescue analgesia.
Results: Both groups were comparable in terms of demographic characteristics. Pain scores were similar at 1 hour post-surgery but significantly lower in the umbilical group at 6, 12, 24, and 48 hours (p=0.001). Only 26% of patients in Group U required rescue analgesia compared to 86% in Group E (p=0.001). The umbilical group demonstrated shorter operative time (127.8±48.4 vs. 159.0±55.6 minutes, p=0.004) and reduced hospital stay (5.9±1.1 vs. 11.2±2.5 days, p=0.001). Moderate extraction difficulty was more frequent in Group U (54% vs. 32%), while mild difficulty was more common in Group E (64% vs. 30%).
Conclusion: Gallbladder retrieval through the umbilical port results in significantly less postoperative pain, reduced analgesic requirements, shorter operative time, and decreased hospital stay compared to epigastric port retrieval. These findings suggest that the umbilical port should be preferred for gallbladder extraction during laparoscopic cholecystectomy when technically feasible.