Postoperative Pain after Gallbladder Retrieval from Umbilical and Epigastric Ports in Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Abstract

Objective: To compare the postoperative pain after gallbladder removal from umbilical port site versus epigastric port site, after four ports laparoscopic cholecystectomy. Methods: Randomized controlled trial was performed from January 2017 till January 2018, at a private hospital setup, with patients of either gender, age 18 years and above, planned laparoscopic cholecystectomy for symptomatic cholelithiasis were considered. Patients having polyps in gallbladder, empyema, mucocele or perforated gallbladder requiring emergency surgery were excluded. They were randomly assigned, 65 patients in which gallbladder removed through umbilical port (group A) and 65 in which epigastric port was used for gallbladder removal (group B). Postoperative pain was determined after one day, at the time of discharge from hospital and after one month of surgery, with the help of Numerical Analogue Scale (NAS). Results: From a total of 130 patients, 65 patients in group A had median (IQR) pain scores of 5 (1.5), 4 (1) and 2 (1) as compared to group B pain scores of 4 (1), 2 (1) and 1 (0.5) at one day post-surgery (p-value=0.000), at discharge from hospital (p-value<0.001) and after a month of surgery (p-value<0.001), respectively. A definitive decline in the postoperative pain scores was evaluated in group B from the day of operation till a month after surgery during follow up visits (p-value<0.001). Conclusion: Epigastric port site removal of gallbladder produced less postoperative pain after removal of gallbladder as compared to the umbilical port site. We therefore are in favor of removal of gallbladder from epigastric port site.