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BACKGROUND AND OBJECTIVES: Laparoscopic cholecystectomy (LC) is a keyhole surgical procedure considered a gold standard treatment for benign gallbladder (GB) diseases. GB retrieval is done per the surgeon's choice through an umbilical or epigastric port. However, postoperative port site infection (PSI) and pain were major complications of this technique. The study aimed to compare the postoperative PSI between epigastric and umbilical ports among patients undergoing LC. METHODS: A prospective randomized controlled trial was conducted among 50 patients who underwent LC for benign GB disease at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, for 6 months. Participants were randomized into epigastric port (n=25) and umbilical port (n=25). Postoperatively, PSI on a postoperative day (POD) of 10 and 30, retrieval difficulty score, Postoperative pain (POP) using a visual analog scale (VAS), and port site scar appearance after 6 months were assessed. RESULTS: This study divided 50 LC patients into epigastric and umbilical ports (n=25). Among them, 31 were females (62%), 19 males (38%), and mean ages of 43.5 ± 10.7 and 40.7 ± 12.6 years were observed for the epigastric and umbilical ports; group age was similar (p=0.37). The gender distribution was similar between groups (p=0.9 for males, p=0.7 for females). The epigastric port displayed a mean body mass index (BMI) of 22.3 ± 1.01, while the umbilical port had a significantly higher mean BMI of 23.7 ± 1.10 (p=0.04). Patients with symptomatic cholelithiasis as the primary reason for surgery were common in both groups (p=0.2 for GB stones, p=0.4 for GB polyps). The mean hospital stays and surgical duration were similar (p=0.7 and 0.99). Epigastric ports had 8% postoperative PSI on POD 10 (vs. 12%, p=0.07) and 0% on POD 30 (vs. 4%, p=1.0), compared to umbilical ports. Umbilical port patients were more satisfied with scar appearance (92% vs. 76%, p=0.11) and less dissatisfied (8% vs. 24%, p=0.02) 6 months post-surgery. Compared to the umbilical port, patients with epigastric ports had significantly higher VAS pain scores at multiple postoperative time points (p-values <0.001 to 0.03). It was also harder to retrieve epigastric port GB (p=0.01). CONCLUSION: The current study highlights the importance of port site selection among patients who underwent LC, as it can notably impact postoperative outcomes. While the umbilical port may be associated with lower PSI rates and better cosmetic outcomes, GB retrieval through the epigastric port may result in lower postoperative port site pain. Surgeons should carefully consider these factors when choosing the port site for LC procedures. Further research, including larger multicenter trials, is needed to validate and expand upon these results, ultimately enhancing patient care in GB surgery.
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Introduction Hemorrhoids are basically anal cushions which turn out to be pathological giving rise to bleeding, pain and protrusion outside the anal canal. The chief complaint of patients with hemorrhoids is bleeding from the rectum which is usually painless and associated with episodes of defecation. The study was done to assess postoperative pain, time duration of the procedure, complications in the postoperative period, return to normal work, and recurrence between the stapler and open hemorrhoidectomy for grade III and IV hemorrhoids. Material and methods The present prospective study was conducted among 60 patients in the General Surgery department at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar over the duration of two years presenting with grade III and IV degree hemorrhoids. Thirty patients each were divided into open hemorrhoidectomy and stapled hemorrhoidectomy groups. The study evaluated variables like operative time, stay at the hospital and postoperative complications and compared them between the two techniques. Follow-up of patients was done at regular intervals. Evaluation of postoperative pain was done using visual analogue scale (VAS) with ranges from 0 to 10. We evaluated the data using the chi-square test with a p-value <0.05 as significant. Results Of 60 patients, 47 (78.3%) were males and 13 (21.7%) were females with a male: female ratio being 3.6:1. The operating time and hospital stay were much less in the stapler hemorrhoidectomy group as compared to the open procedure group. Also, postoperative pain (visual analogue scale) was less in the stapler hemorrhoidectomy group with 36.7% of patients presenting with pain at one week, 23.3% at one month and 3.3% at three months in the open hemorrhoidectomy group whereas 13.3% presenting as pain in one week, 10% presenting at one month and none presenting at three months in the stapler hemorrhoidectomy group. There was recurrence seen in 10% of cases at three months in the open hemorrhoidectomy group as compared to the stapler hemorrhoidectomy group where no recurrence was found at three months follow-up. Conclusion Hemorrhoid offers a variety of surgical modalities of treatment. We have come to the conclusion that stapled hemorrhoidectomy has less complications and good patient compliance. It can be an effective option in the treatment of third and fourth-grade hemorrhoids. With proper training and expertise, stapler hemorrhoidectomy is a better and reliable technique for hemorrhoid surgery.
