Comparative Study of Port-Site Pain After Gallbladder Extraction via Epigastric vs Umbilical Port

Abstract

Background: Laparoscopic cholecystectomy (LC) is the gold-standard treatment for symptomatic gallstones[1]. However, port-site pain remains a common morbidity that can prolong recovery. Gallbladder specimens are usually removed through either the umbilical or epigastric (subxiphoid) trocar site, but evidence on which site causes less postoperative pain is mixed[4][5]. We conducted a comparative observational study to determine whether retrieval via the epigastric port results in less postoperative port-site pain than the umbilical port.

Materials and Methods: Eighty adult patients undergoing elective four-port LC were allocated to two groups (n=40 each) based on the port used for gallbladder extraction. Group U (umbilical port) and Group E (epigastric port) were comparable in demographics (mean age ~52.7±11.8 years, ~62% female) and comorbidities. All patients received standard perioperative care and postoperative analgesia (intravenous paracetamol). Pain at the extraction site was assessed by Visual Analog Scale (VAS, 0–10) immediately post-op and at 1, 6, 12, 24 hours, and on discharge. Operative variables (surgery duration, specimen retrieval time, need for port incision enlargement) and complications were recorded. Data were analyzed by t-tests and χ²; p<0.05 was considered significant.

Results: Baseline characteristics (age, gender, BMI, ASA, comorbidity profile) did not differ significantly between groups. The mean operative time was significantly longer in Group U (78.3±16.2 min) than Group E (66.6±16.7 min, p=0.011). Likewise, mean gallbladder retrieval time was longer via the umbilical port (19.8±6.9 sec) than via the epigastric port (14.9±1.7 sec, p<0.001). Enlarging the fascial incision was required more often for umbilical extraction (8 of 40 patients, 20%) than epigastric (1 of 40, 2.5%; p=0.001). Surgical site infection (SSI) rates were low and similar (umbilical 3/40 vs epigastric 1/40; p=0.18).

Port-site pain scores were markedly lower in the epigastric group after the immediate postoperative period. Figure 1 shows that both groups had very high pain immediately post-op (mean VAS≈9.5), but at 1 h and thereafter, Group E consistently reported lower VAS scores than Group U. At 1 h (7.05±0.41 vs 7.73±0.69), 6 h (5.96±0.61 vs 6.74±0.69), 12 h (7.05±0.41 vs 7.53±0.68), 24 h (6.05±0.64 vs 6.53±0.68), and on discharge (3.27±1.21 vs 4.35±1.21), the differences were highly significant (p<0.001 for each time point). The immediate postoperative VAS did not differ significantly (9.32 vs 9.50, p=0.19). In summary, epigastric retrieval was associated with significantly lower postoperative pain scores than umbilical retrieval at all measured intervals after the immediate post-op period. (Tables 1–3 summarize demographics, intraoperative details, and pain outcomes; Figures 2–3 illustrate retrieval/surgery times and complication rates.)

Conclusion: In this study, retrieving the gallbladder via the epigastric port significantly reduced port-site pain and shortened operative time compared to umbilical extraction. No difference was found in infection rates. These findings suggest the epigastric site may be preferable for specimen extraction to minimize pain. However, the literature is mixed: some studies and meta-analyses have found no difference or even favor umbilical retrieval for pain[4][5]. Further randomized trials are warranted.