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Umbilical Port Site in Laparoscopic Cholecystectomy
Only the umbilical fascia is closed, with a hand-sewn interrupted statistically, using the Chi-square test, showing a not statistically
suture using 0 polyglactin 910 (Vicryl, Ethicon). The skin is closed significant results (p >0.05)
applying staples, in all cases. Southampton scoring system was applied to all the umbilical
The same surgical tools were adopted to perform the VLC wounds. The values are reported in Figure 3.
operative technique in all 960 cases.
Postoperative dressings were performed routinely at 1, 5, and • In the control group, Southampton scoring system reveals in
10 postoperative days (POD), and in the last dressing, the stitches 144 cases scored a grade 0—normal healing (45%); 38 cases
were removed. scored grade I—normal healing with mild bruising or erythema
Protocol for the control group, no topical antibiotic application (12%); 86 cases scored grade II—erythema plus other signs
was expected. The dressing was performed only with disinfection of inflammation (27%); 24 cases scored grade III—clear or
of the wounds using iodopovidone and replacement of the patch. haemoserous discharge (7%); 19 cases scored grade IV—pus/
The procedure for the patients belong to rifamycin and purulent discharge (6%); and 9 cases scored grade V—deep o
gentamicin group had the identical stages as the aforementioned severe wound infection (3%).
protocol, but rifamycin and gentamicin was applied according to • In the Rifamycin group, Southampton scoring system reveals in
following scheme: 152 cases scored a grade 0 (48%), 85 cases scored grade I (27 %),
66 cases scored grade II (21 %), 7 cases scored grade III (2%),
• Preoperative phase: Twelve hours before VLC, application on 5 cases scored grade IV (1%), and 5 cases scored grade V (1%).
the umbilical and periumbilical skin of iodopovidone, affixing • In the Gentamicin group, Southampton scoring system reveals in
a sterile patch with 3 mL of rifamycin (RG) or gentamicin (GG) 159 cases scored a grade 0 (49%), 80 cases scored grade I (25 %),
on the umbilicus. 60 cases scored grade II (19 %), 10 cases scored grade III (3%),
• Intraoperative phase: After suturing the umbilical access, the 6 cases scored grade IV (2%), and 5 cases scored grade V (2%).
area is disinfected and then was affixed a sterile patch with 3 mL
of rifamycin (RG) or gentamicin (GG) on the umbilical wound.
• Postoperative phase: At each dressing, application of sterile
patch with 3 mL of rifamycin (RG) or gentamicin (GG) on the
umbilical wound (1, 5, 10 POD).
The assessed features were the following: (1) pain insisted on
umbilical region (pain scale from 0 to 10); (2) analgesic drugs to
treat umbilical region pain; (3) signs of phlogosis of the umbilical
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wound defined according to the Southampton score as follow:
grade 0: normal healing, grade I: erythema, grade II: erythema
plus additional signs, grade III: haemoserous release, grade IV: pus
discharge, grade V: severe wound infection.
On the 90th post-VLC day, the incidence of incisional hernia in
the umbilical region was recorded.
Statistical Analysis
Collected data were examined using statistical package for social
sciences software (SPSS version 11.0) by means of the analysis
of variance (ANOVA) test to compare the means of independent Fig. 1: Mean value pain score
samples, and Chi-square test used for categorical variables.

results
During the last dressing, all patients were asked for the value of pain
during the postoperative period and the possible use of painkillers
(administration for more than 2 days).
The first graph shows (Fig. 1) the mean values of the
postoperative notes of pain localized on the umbilical area in
patients in each groups.
The means of this three independent samples (treatments) have
been analyzed using ANOVA test. There is a statistically significant
differences, between the pain values reported among these three
groups with a lower values in the RG and GG groups (p <0.001).
The second graph (Fig. 2) shows the percentages of patients
in each group, who reported taking pain relievers for more than
2 days in the postoperative period.
In the CG, 250 patients revealed that they had taken pain-
relieving drugs (for a period longer than 2 days), 198 patients
in the RG, and 203 in the GG. The data obtained were analyzed Fig. 2: Analgesic drugs

202 World Journal of Laparoscopic Surgery, Volume 14 Issue 3 (September–December 2021)