A Randomized Controlled Trial To Compare The Outcomes Between The Conventional And Modified Epigastric Port Insertion Techniques In Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy (LC) is one of the most frequently done abdominal surgeries and is the standard of care for symptomatic cholelithiasis. LC is associated with good surgical results, insignificant blood loss, reduced severity of postoperative pain, and early discharge. Port site pain depends on the type and the method of trocar insertion as well as the nociceptive impulse can be from both the skin incision and the muscle damage and intramuscular hematoma that can occur during the port insertion. One of the important aspects of laparoscopic cholecystectomy is the proper port position in relation to the target organ of dissection. Although there is no controversy about the position of umbilical, right  subcostal (midclavicular) and right anterior axillary ports in laparoscopic cholecystectomy, but there is no uniform consensus about the position of epigastric port. Conventionally epigastric port is inserted to the right of falciform ligament. In literature, position to the left of ligament is also mentioned. As in the modified technique of epigastric port insertion the port is inserted directly under vision through the linea alba instead of the muscle fibres there is less expected chances of muscle injury and intramuscular bleed. Lack of literature comparing both the above-mentioned techniques of epigastric port insertion especially with respect to the epigastric port site pain.The purpose of this study is to define the optimal epigastric port position for laparoscopic cholecystectomy by comparing the outcomes between conventional and modified epigastric port insertion techniques in laparoscopic cholecystectomy  with respect to parameters like postoperative pain, total requirement of postoperative analgesia, gallbladder retrieval time, total duration of surgery and port site infection (SSI).