Epigastric port retrieval of the gallbladder following laparoscopic cholecystectomy is associated with the reduced risk of port site infection and port site incisional hernia: An updated meta-analysis of randomized controlled trials☆
An updated meta-analysis providing better evidence on gall bladder extraction port following laparoscopic cholecystectomy(LC).
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Epigastric port retrieval of gallbladder following LC has advantage of reduced rate of both infection and incisional hernia.
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Umbilical port retrieval of gallbladder following LC has advantage of reduced pain, port site bleeding and perforation risk.
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In conclusion from this meta-analysis epigastric port retrieval seems to be more advantageous compared to the umbilical port.
Abstract
Aims
The objective of this article is to compare the surgical outcomes for epigastric port or umbilical port retrieval of the gallbladder (GB) following laparoscopic cholecystectomy (LC).
Methods
The data retrieved from the published randomized, controlled trials (RCT) comparing the surgical outcomes for epigastric port or umbilical port retrieval of the GB following LC was analysed using the principles of meta-analysis. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR).
Results
Eight RCTs on 2676 patients comparing the surgical outcomes for epigastric port or umbilical port retrieval of the GB following LC were analysed. In the random effects model analysis using the statistical software Review Manager 5.3, the GB retrieval through epigastric port was associated with the reduced duration of operation (SMD, 0.41; 95% CI, 0.18, 0.64; z = 3.52; P = 0.0004). Epigastric retrieval was also associated with reduced risk of surgical site infection (OR, 1.95; 95% CI, 0.75, 5.11; z = 1.36; P = 0.17), and port site incisional hernia (OR, 4.22; 95% CI, 0.43, 41.40; z = 1.24; P = 0.22) compared to umbilical port retrieval though it did not reach statistical significance. The need for port enlargement to retrieve the GB was similar in both groups. In contrast, the umbilical port retrieval of the GB was associated with significantly less post-operative pain (SMD, −0.51; 95% CI, −0.95, −0.06; z = 2.24; P = 0.03), reduced GB perforation rate, reduced port site bleeding rate and reduced difficulty in GB retrieval.
Conclusion
GB retrieval through epigastric port following LC has clinically proven advantage of reduced retrieval site infection rate, lower operation time and incisional hernia rate but at the cost of increased pain at 24 h, higher risk of GB perforation, port site bleeding and technical difficulties.
https://doi.org/10.1002/bjs.11341 The provisional abstract of this article has been presented at the Annual General Meeting of the Associations of Surgeons of Great Britain and Ireland in Telford on 7th-9th May 2019. It is published in the Supplement issue of the British Journal of Surgery 2019.
