Umbilical versus epigastric port for gallbladder extraction in laparoscopic cholecystectomy: an updated systematic review and meta-analysis of randomized controlled trials with trial sequential analysis and GRADE assessment
- Journal
- HPB : the official journal of the International Hepato Pancreato Biliary Association (Q1)
- Published
- 6 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Osama M Aldeeb, Ahmad O Saleh, Bara M Hammadeh, Rania Rashed, Tuqa M Alfreijat, Rahaf Hanoun, et al.
- PMID
- 42521521
- DOI
- 10.1016/j.hpb.2026.06.018
Why clinicians should know about it
- Picked for Hepatology (top studies of the week, 2 August 2026).
- Picked for Gastroenterology (top studies of the week, 2 August 2026): Meta‑analysis of port site for cholecystectomy, surgical focus
Abstract
BACKGROUND: In laparoscopic cholecystectomy, the gallbladder is removed via the umbilical or epigastric/subxiphoid port. AIMS: We aim to compare the umbilical and epigastric ports for gallbladder extraction in laparoscopic cholecystectomy in terms of postoperative pain, surgical site infection, postoperative hernia, operating time, and gallbladder retrieval time. METHODS: Systematic review and meta-analysis of randomized controlled trials from PubMed, Scopus,WOS, CENTRAL, and Clinicaltrials.gov from inception to 18 June 2025. PROSPERO ID (CRD420251143624). RESULTS: Analysis of 20 RCTs showed that gallbladder extraction via the umbilical port was associated with significant reduction in postoperative pain at 1 h (SMD:-1.31, 95%CI:-2.14; -0.49, p = 0.0018), 6 h (SMD:-3.21, 95%CI:-5.71; -0.70, p = 0.0121), 12 h (SMD:-3.06, 95%CI:-5.40; -0.71, p = 0.0107), 24 h (SMD:-1.96, 95%CI:-3.71; -0.21, p = 0.0283), and 36 h (SMD:-0.98, 95%CI:-1.28; -0.69, p < 0.0001). PIs crossed the null for time points except 36 h. No significant differences were observed at 48, 72 h, 7, or 30 days. Umbilical port was associated with longer hospital stay (MD:1.79 days, 95%CI:0.54; 3.04, p = 0.0050, PI:-0.24; 3.82). No differences were found for surgical site infection, hernia, operative time, extraction time, or retrieval difficulty, PIs frequently crossed the null. CONCLUSION: Extraction via the umbilical port was associated with statistically significant reduction in early postoperative pain. Wide PIs crossing the null indicate substantial uncertainty. Neither port site demonstrates definitive advantage; selection should be guided by surgeon preference and patient-specific factors.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.