Comparative analysis of surgical site infection rates between transumbilical and periumbilical incisions in laparoscopic cholecystectomy: a randomized controlled trial

Abstract

Background: Laparoscopic cholecystectomy is the standard treatment for gallstone disease offering advantages such as minimal incision size and rapid recovery. The study compares the surgical site infection (SSI) rates between transumbilical (TUI) and periumbilical incisions (PUI) in this method. Methods: A randomized controlled trial was conducted from December 2021 to December 2023 at Panyananthaphikkhu Chonprathan Medical Center, Thailand. Patients undergoing laparoscopic cholecystectomy were randomly assigned to TUI or PUI groups. The primary endpoint was SSI rate, with secondary endpoints including length of hospital stay, operative time, blood loss, conversion rate, complications, cosmetic satisfaction, pain score, wound hypersensitivity, and numbness. Results: A total of 156 patients were enrolled, with 78 patients in each group. The incidence of SSI was 14.1% in the TUI group and 10.3% in the PUI group (p = 0.46). There were no conversions to open surgery, bile leaks, intra-abdominal infections, reoperations, or mortalities observed in either group. Outcomes related to cosmetic satisfaction, wound numbness, and wound hypersensitivity were comparable between the groups. Patients who developed SSI demonstrated lower cosmetic satisfaction scores on postoperative day 7 surgery (8.47 ± 1.3) compared to those without SSI (9.5 ± 0.8) (p < 0.001), although these scores were similar by day 30. Additionally, the SSI group exhibited a higher prevalence of umbilical wound hypersensitivity on day 30 post-surgery [11 (57.9%) vs. 35 (25.7%), p = 0.04]. Conclusions: SSI rates and other surgical outcomes were comparable between TUI and PUI in laparoscopic cholecystectomy, encouraging the use of either technique based on surgeon preference and patient-specific factors.