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Comparison of postoperative pain at umbilical wound after conventional laparoscopic cholecystectomy between transumbilical and infraumbilical incisions: a randomized control trial

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Abstract

Background

Transumbilical incision has been applied in single-incision laparoscopy. Evidence for the effect of transumbilical incision on postoperative pain compared with infraumbilical incision is still lacking.

Methods

A randomized controlled trial (RCT) was conducted in a university hospital. Patients who underwent conventional laparoscopic cholecystectomy were randomized to have transumbilical or infraumbilical incision. Postoperative pain was measured using visual analog score at 6, 24 h, and 7 days post operation. Secondary outcomes were analgesic usage, length of stay, superficial surgical site infection (SSI), wound numbness, and hypersensitivity. Risk ratio and mean difference (MD) along with their 95% confidence intervals (CIs) were estimated. Adjusted analysis was done, if clinical unbalanced characteristics presented. The study was registered at http://ClinicalTrial.gov (ID NCT02738710).

Results

A total of 102 patients were enrolled in which 51 patients were randomized to each interventional group. Postoperative pain was not significantly different between the groups with the MD of − 0.07 (95% CI − 0.47, 0.35). Paracetamol usage was significantly 1 tab (95% CI − 1.9, − 0.1) less after transumbilical incision, but this was not significant after adjusting for unbalanced characteristics. Superficial SSI rate was much higher in the transumbilical than the infraumbilical group, i.e., 16 versus 4%, but this was not significant (p = 0.070). Satisfaction scores at 3 months were not different between the groups, with the corresponding means of 8.9 [standard deviation (SD) 1.3] and 9.0 (SD 1.0).

Conclusions

Transumbilical incision had non-significant different pain compared to infraumbilical incision. Most patients in both groups were satisfied with the operation at 3 months. A further large RCT is required for comparing SSI between the two incisions.

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Acknowledgements

We would like to thank Dr. Amornpon Kanlerd and Dr. Pakkavuth Chanwangphuvana for helping us to enroll patients and support the study.

Funding

This study was funded by Faculty of Medicine, Thammasat University Hospital with Grant Number of 1-08/2559.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand

    Boonying Siribumrungwong, Trirat Chunsirisub, Palin Limpavitayaporn, Assanee Tongyoo, Ekkapak Sriussadaporn, Chatchai Mingmalairak & Weerayut Thowprasert

  2. Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand

    Boonying Siribumrungwong

  3. Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI road, Rachatevi, Bangkok, 10400, Thailand

    Ammarin Thakkinstian

Authors
  1. Boonying Siribumrungwong
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  2. Trirat Chunsirisub
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  3. Palin Limpavitayaporn
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  4. Assanee Tongyoo
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  5. Ekkapak Sriussadaporn
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  6. Chatchai Mingmalairak
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  7. Weerayut Thowprasert
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  8. Ammarin Thakkinstian
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Corresponding author

Correspondence to Ammarin Thakkinstian.

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Disclosures

The study was funded by Faculty of Medicine, Thammasat University with Grant Number of 1-08/2559. Boonying Siribumrungwong,Trirat Chunsirisub, Palin Limpavitayaporn, Assanee Tongyoo, Ekkapak Sriussadaporn, Chatchai Mingmalairak, Weerayut Thowprasert, Ammarin Thakkinstian have no conflict of interests or financial ties to disclose.

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Siribumrungwong, B., Chunsirisub, T., Limpavitayaporn, P. et al. Comparison of postoperative pain at umbilical wound after conventional laparoscopic cholecystectomy between transumbilical and infraumbilical incisions: a randomized control trial. Surg Endosc 33, 1578–1584 (2019). https://doi.org/10.1007/s00464-018-6447-y

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  • DOI: https://doi.org/10.1007/s00464-018-6447-y

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