Jain Arihant, Tajudeen Muhamed, Sreekanth Amith, Raj Kumar Nagarajan
Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND.
Cureus. 2021 Sep 18;13(9):e18087. doi: 10.7759/cureus.18087. eCollection 2021 Sep.
Introduction Gallbladder (GB) retrieval is an important cause of postoperative pain (POP) after laparoscopic cholecystectomy (LC). Retrieval is through the epigastric or umbilical port based on the surgeon's preference. There is limited evidence to support the superiority of one port over the other in terms of POP. This study was done to compare POP between epigastric and umbilical ports after GB retrieval in LC for symptomatic cholelithiasis. Material and methods All patients who underwent elective LC for symptomatic cholelithiasis were randomized for GB retrieval either through the umbilical (n = 15) or epigastric (n = 15) port. Postoperatively, the retrieval difficulty score by the operating surgeon, visual analog scale (VAS) scores for pain, and surgical site infection (SSI) by postoperative day (POD) 10 and 30 were assessed. Results The mean visual analog scores at the umbilical port at 1, 6, 12, 24, and 36 hours postoperatively were 5.20 ± 0.86, 4.60 ± 0.74, 4.00 ± 0.53, 3.40 ± 0.08, and 2.73 ± 0.82, which were significantly less than the visual analog scores at the epigastric port at the same time intervals, measuring 6.06 ± 1.34, 5.87 ± 1.30, 5.27 ± 1.16, 4.73 ± 1.10, and 3.93 ± 1.03, respectively. The difference was statistically significant between the two arms (p-value < 0.05). The mean retrieval difficulty score was significantly less for the umbilical port (4.40 ± 0.74) when compared with the epigastric port (5.13 ± 0.55). The overall SSI rate in the present study was 10%, and three (20%) patients in the epigastric port group developed SSI by POD 10, while none in the umbilical port group developed SSI. Conclusion GB retrieval from the umbilical port is associated with less POP, SSI, and retrieval difficulty when compared with GB retrieval from the epigastric port after elective LC for symptomatic cholelithiasis. Titration of analgesic use can also be done appropriately, reducing the dose of analgesics after 12-24 hours.
引言
胆囊取出是腹腔镜胆囊切除术后疼痛（POP）的一个重要原因。根据外科医生的偏好，通过上腹部或脐部端口进行取出操作。关于术后疼痛方面，支持一个端口优于另一个端口的证据有限。本研究旨在比较有症状胆结石行腹腔镜胆囊切除术时，经上腹部和脐部端口取出胆囊后的术后疼痛情况。
材料与方法
所有因有症状胆结石接受择期腹腔镜胆囊切除术的患者，随机分为经脐部端口（n = 15）或上腹部端口（n = 15）取出胆囊。术后，评估手术医生的取出难度评分、疼痛视觉模拟量表（VAS）评分以及术后第10天和第30天的手术部位感染（SSI）情况。
结果
术后1、6、12、24和36小时，脐部端口的平均视觉模拟评分分别为5.20±0.86、4.60±0.74、4.00±0.53、3.40±0.08和2.73±0.82，显著低于同一时间间隔上腹部端口的视觉模拟评分，分别为6.06±1.34、5.87±1.30、5.27±1.16、4.73±1.10和3.93±1.03。两组之间差异具有统计学意义（p值<0.05）。与上腹部端口（5.13±0.55）相比，脐部端口的平均取出难度评分显著更低（4.40±0.74）。本研究中的总体手术部位感染率为10%，上腹部端口组有3例（20%）患者在术后第10天发生手术部位感染，而脐部端口组无患者发生手术部位感染。
结论
对于有症状胆结石行择期腹腔镜胆囊切除术后，与经上腹部端口取出胆囊相比，经脐部端口取出胆囊与更少的术后疼痛、手术部位感染及取出难度相关。还可适当调整镇痛药物的使用，在12 - 24小时后减少镇痛药剂量。
