A Comparison of Cosmetic Outcome of Periumbilical versus Intraumbilical Incision in Laparoscopic Appendectomy and Cholecystectomy-A One Year Randomised Controlled Trial

Abstract

Laparoscopic surgeries are advantageous over open surgeries in terms of minimal tissue handling, earlier return of bowel function, less postoperative pain, better cosmesis, lesser duration of hospital stay, earlier return to full activity and decreased overall cost. The incidence of bowel injuries is 0.13%, vascular injuries is 0.05-2% and abdominal wall vascular injuries 0.2-2%. Therefore, safe abdominal entry in laparoscopy is a major concern. Considering the fact that initial entry to abdominal cavity is a blind procedure, there is no ideal entry site. Various entry points used are Umbilicus, Palmar’s point, Jain point, Lee-Huang point, etc. The current study aimed to compare the better cosmetic outcome between trans umbilical and periumbilical incision for primary port insertion in cases of Laparoscopic Appendicectomy and Laparoscopic Cholecystectomy. This is a one year RCT done in Department of General Surgery, KLEs Dr.Prabhakar Kore Hospital and Medical Research Centre, Belagavi, from January 2022-December 2022. A total of 100 patients operated for laparoscopic appendectomy and laparoscopic cholecystectomy were studied. The patients were divided into Group A and Group B based on type of incision taken either periumbilical or transumbilical. Postoperative cosmetic outcome was analyzed using POSAS score on post op day 3,7 and 1-month follow up. The results are statistically significant (P<0.05). Between the two incisions during POD# 3 and 7 there is significant difference between variables such as induration, erythema, SSI. In our study 3 cases had SSI in both the groups. Transumbilical incision has better cosmetic satisfaction compared to Periumbilical incision.