Postoperative port-site pain after gall bladder retrieval from epigastric vs. umbilical port in laparoscopic cholecystectomy: A randomized controlled trial

Objective: To determine whether gall bladder (GB) retrieval from umbilical port is associated with more pain at port site as compared to GB retrieval from epigastric port in adult patients undergoing four port elective laparoscopic cholecystectomy at a tertiary care hospital. Methods: Adult patients, who were undergoing elective laparoscopic cholecystectomy during a six month period in 2010 at our institute, were randomized to either group A (n = 60, GB retrieval through epigastric port) or group B (n = 60, GB retrieval through umbilical port). VAS for pain was assessed by a registered nurse at 1, 6, 12, 24 and 36 h after surgery. Results: The VAS for pain at umbilical port was less than epigastric port at 1, 6, 12, 24 and 36 h after surgery (5.9 +/- 1.1 vs. 4.1 +/- 1.5, 4.6 +/- 0.94 vs. 3.5 +/- 1.05, 3.9 +/- 0.85 vs. 2.4 +/- 0.79, 3.05 +/- 0.87 vs. 2.15 +/- 0.87, respectively) and the difference was statistically significant (p-value < 0.001). Multiple linear regression was done for port site pain at 24 h and the VAS at umblical port was less than epigastric port with VAS difference of 0.9 after adjusting for age, sex, duration of surgery and additional analgesia use (r(2) = 0.253, p-value < 0.001). Conclusion: Gall bladder retrieval from umbilical port is associated with lower port site pain than GB retrieval from epigastric port in patients undergoing elective laparoscopic cholecystectomy. We recommend umbilical port for gall bladder retrieval. (C) 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.