Epigastric port site complications and affecting factors used for gallbladder specimen extraction in laparoscopic cholecystectomy

INTRODUCTION: Complications occur at the port site where the specimen is excised after laparoscopic cholecystectomy (LC). In this study, it was aimed to investigate port-site complications.
METHODS: The results of patients who underwent LC surgery in our center between January 01, 2018, and December 31, 2020, were retrospectively analyzed. Patients who were decided to have open surgery and reside abroad were excluded from the study. Pre operative, intraoperative, and post-operative factors of all patients, which were considered to impact the development of complications, were noted down.
RESULTS: A total of 357 patients were included in the study. A total of 24 (6.7%) patients had epigastric trocar site infection (EPSI). It was found out that trocar site hematoma was a risk factor causing a 39.37-fold increase in the development of EPSI (<0.001) (95% confidence interval =10.69–144.97), while dilatation at the trocar site was a risk factor causing a 3.1-fold increase (p=0.027) (95% confidence interval =1.14–8.48). Ten patients had epigastric trocar insertion site hernia (EPSH). As a result of the multivariant analysis, it was determined that the development of EPSI caused the development of EPSH 27.59 times more (95% confidence interval =5.92–128.7) (p<0.001), while the accompanying additional laparoscopic procedure caused the development of EPSH 6.2 times more (95% confidence interval =6.2–1.17) (p=0.032).
DISCUSSION AND CONCLUSION: Preventing the occurrence of hematoma in the epigastric trocar insertion site, where the specimen is excised after LC surgery, reduces the risk of EPSI, and indirectly reduces the incidence of EPSH. Moreover, we recommend careful follow-up for EPSH in patients who underwent additional laparoscopic surgery during LC.