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RESEARCH ARTICLE
Umbilical Port Site in Laparoscopic Cholecystectomy: A

Possible Strategy to Avoid Complications

3
1
2
Mario Pacilli , Nicola Tartaglia , Giovanna Pavone , Antonio Ambrosi 4
AbstrAct
Laparoscopic cholecystectomy is the gold standard for the surgical treatment of symptomatic cholecystolithiasis. A skin incision is made above
the umbilicus, an area that is infrequently exposed to UV light, soaps, and contains a large amount of bacteria. The purpose of this study is to
examine the effect of the use of topical prophylactic antibiotic to prevent post-videolaparo-cholecystectomy infection at the umbilical port site.
Our outcomes display that in patients treated with topical antibiotics, umbilical port site infections occurred less often than in the patients not
treated. Further studies are required to determine what other procedures should be engaged to decrease the high rate of infections.
Keywords: Laparoscopic cholecystectomy, Topical antibiotic therapy, Umbilical port site infection.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1472

IntroductIon 1–4 Department of Surgical and Medical Sciences, University of Foggia,
Elective laparoscopic cholecystectomy, also known as minimally Foggia, Apulia, Italy
invasive cholecystectomy, has become the treatment of choice Corresponding Author: Nicola Tartaglia, Department of Surgical and
for the surgical treatment of symptomatic cholecystolithiasis. 1,2 Medical Sciences, University of Foggia, Foggia, Apulia, Italy, Phone:
It is performed through four small incisions, two ports of 10 mm +39 3204394640, e-mail: nicola.tartaglia@unifg.it
and two additional 5 mm entrees each in the standard position How to cite this article: Pacilli M, Tartaglia N, Pavone G, et al. Umbilical
with the legs opened. 3 Port Site in Laparoscopic Cholecystectomy: A Possible Strategy to
The skin should be cut for about 10–12 mm approximately in Avoid Complications. World J Lap Surg 2021;14(3):201–204.
length just above the umbilicus. The subcutaneous fat is dissected Source of support: Nil
with the help of forceps and scissors. The abdominal fascia is Conflict of interest: None
elevated with the Kocher hemostatic forceps, and a little incision
is made through the fascia. The peritoneum is exposed and
opened carefully by a scalpel. Sutures through abdominal fascia
are positioned to lock the Hasson port. The selected patients were randomized into three groups:
The umbilicus is a zone of the body that is not set out to UV Rifamycin group (RG): 320 patients treated by application of rifamycin
light, rarely cleansed, and contains a large amount of bacteria. 4 on the site; Gentamicin group (GG), 320 patients was treated with
The minimal skin injury during laparoscopic cholecystectomy gentamicin; and control group (CG) was not treated (320 patients).
guarantees a lower risk of wound infection, but umbilical port site Rifamycin and gentamicin are often utilized on the skin for
infection in laparoscopic cholecystectomy procedure is reported the treatment of contaminations caused by germs, founded on
5,6
to be 9% especially for a difficult operation. the specific evidences about the drug. Skin plagues, pyodermitis,
The aim of this study was to investigate how the use of topical dermatitis, abscesses, infected wounds, and exposed trauma are
prophylactic antibiotic can improve post-VLC infection rate at the some examples.
umbilical port site, because there is no scientific agreement on
the practice of it. Surgical Technique and Administration of Antibiotic
Therapy
MAterIAls And Methods Systemic antibiotic prophylaxis was applied, to all patients, with
prophylactic intravenous administration of 2 g of cefazolin.
Study Design and Participants Immediately before of the operation, surgical field was prepared
From September 2013 to December 2019, more than 1,200 patients by washing all the abdomen, disinfection by iodopovidone (focus
with cholecystolithiasis underwent VLC, in the Division of General on umbilical and periumbilical skin), and final step with 0.9% saline
Surgery, Department of Surgical and Medical Sciences of the solution.
University of Foggia, School of Medicine, Polyclinic of Foggia, A 12-mm Hasson trocar was inserted through the umbilicus
Italy. Nine-hundred and sixty patients were analyzed in the study, incision and three supplementary trocars (5 mm at the right
affected by the same clinical scenario. quadrant for the left surgeon’s hand, 10 mm at the upper left
Exclusion criteria were patients who used antibiotics during quadrant for the right hand, finally to divaricate the liver 5 mm, at
the previous 7 days (for causes unrelated to the surgery), finding of the epigastrium) were introduced. An anterograde cholecystectomy
unpredicted acute cholecystitis, unintentional gallbladder rupture, is performed, and the gallbladder is pulled out through the
and change to an open procedure. umbilical incision always with a protection container.

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