A Comparison of Cosmetic Outcome of Periumbilical versus Intraumbilical Incision in Laparoscopic Appendectomy and Cholecystectomy-A One Year Randomised Controlled Trial
Main Article Content
Abstract
Laparoscopic surgeries are advantageous over open surgeries in terms of minimal tissue handling, earlier return of bowel function, less postoperative pain, better cosmesis, lesser duration of hospital stay, earlier return to full activity and decreased overall cost. The incidence of bowel injuries is 0.13%, vascular injuries is 0.05-2% and abdominal wall vascular injuries 0.2-2%. Therefore, safe abdominal entry in laparoscopy is a major concern. Considering the fact that initial entry to abdominal cavity is a blind procedure, there is no ideal entry site. Various entry points used are Umbilicus, Palmar’s point, Jain point, Lee-Huang point, etc. The current study aimed to compare the better cosmetic outcome between trans umbilical and periumbilical incision for primary port insertion in cases of Laparoscopic Appendicectomy and Laparoscopic Cholecystectomy. This is a one year RCT done in Department of General Surgery, KLEs Dr.Prabhakar Kore Hospital and Medical Research Centre, Belagavi, from January 2022-December 2022. A total of 100 patients operated for laparoscopic appendectomy and laparoscopic cholecystectomy were studied. The patients were divided into Group A and Group B based on type of incision taken either periumbilical or transumbilical. Postoperative cosmetic outcome was analyzed using POSAS score on post op day 3,7 and 1-month follow up. The results are statistically significant (P<0.05). Between the two incisions during POD# 3 and 7 there is significant difference between variables such as induration, erythema, SSI. In our study 3 cases had SSI in both the groups. Transumbilical incision has better cosmetic satisfaction compared to Periumbilical incision.
Keywords:
Cosmetic Outcome, Periumbilical versus Intraumbilical Incision, Laparoscopic Appendectomy, Cholecystectomy, Periumbilical Incision, Intraumbilical Incision
Article Details
How to Cite
KEERTHI, Dr. M. Sravya; KORE, Dr. S. S. Shimi; TOGALE, Dr. Manoj D..
A Comparison of Cosmetic Outcome of Periumbilical versus Intraumbilical Incision in Laparoscopic Appendectomy and Cholecystectomy-A One Year Randomised Controlled Trial.
Medical Research Archives, [S.l.], v. 11, n. 6, june 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3955>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v11i6.3955.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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23. LJ Draaijers, FR Tempelman, YA Botman, WE Tuinebreijer, E Middlekoop, RW Kreis, PP Van Zuijlen. The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. PlastReconstrSurg 2004 Jun; 113(7): 1960-5.
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26. MI Ibrahim , GF Moustafa, AS Al-Hamid ,MR Hussein . Superficial incisional surgical site infection rate after cesarean section in obese women: a randomized controlled trial of subcuticular versus interrupted skin suturing. Arch Gynecol Obstet. 2014 May;289(5):981-6
27. AD Mackeen, M Schuster ,V Berghella. Suture versus staples for skin closure after cesarean: a metaanalysis. Am J Obstet Gynecol. 2015 May;212 (5):621
28. Maingot's Abdominal Operations, 13e. Michael J. Zinner, Stanley W. Ashley, O. Joe Hines
29. Senturk, Mehmet Baki, et al. "Cosmetic outcomes of infraumbilical, supraumbilical, and transumbilical entry routes in laparoscopic surgery." Turkish Journal of Surgery, vol. 34, no. 4, 2018, p. 290+.
30. Fathi AH, Soltanian H, Saber AA. Surgical anatomy and morphologic variations of umbilical structures. Am Surg. 2012 May;78(5):540-4. PMID: 22546125.
31. Oh, Chang-Seok et al. “Morphologic variations of the umbilical ring, umbilical ligaments and ligamentum teres hepatis.” Yonsei medical journal vol. 49,6 (2008): 1004-7. doi:10.3349/ymj.2008.49.6.1004
32. Janosko EO, Jona JZ, Belin RP. Congenital anomalies of the umbilicus. Am Surg. 1977 Mar;43(3):177-85. PMID: 557306.
33. Hill, M.A. (2020, September 16) Embryology Book - Umbilicus (1916) 2
34. Yamamoto, M. et al. “Does Transumbilical Incision Influence Surgical Site Infection Rates of the Laparoscopic Sigmoidectomy and Anterior Resection?” The American Surgeon 81 (2015): 1232 - 1236.
35. Asakuma, M. et al. “A Concealed “Natural Orifice”: Umbilicus Anatomy for Minimally Invasive Surgery.” Surgical Innovation 26 (2019): 46 - 49.
36. Amarini, Rebekah et al. “Facilitation of Wound Healing Following Laparoscopic and Conventional Abdominal Surgery with Dressings, Patches, Antibiotics, etc.” (2019).
37. Dwivedy, Preshak et al. “Open Versus Laparoscopic Appendicectomy in a Tertiary Care Center – A Randomized Controlled Study.” (2020).
38. Sinha, Animesh and Buridi Kalyana Ramu. “A COMPARATIVE STUDY BETWEEN OPEN CHOLECYSTECTOMY AND LAPAROSCOPIC CHOLECYSTECTOMY IN RURAL MEDICAL COLLEGE SET UP.” Journal of Evolution of medical and Dental Sciences 3 (2014): 14663-14671.
39. Anderson, R. E. and J. Hunter. “Laparoscopic Cholecystectomy Is Less Expensive than Open Cholecystectomy.” Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 1 (1991): 82–84.
40. Reddy, B. V.. “Pain and Duration Scoring Between Open and Laparoscopic Cholecystectomy Dr.” (2016).
41. Kim, E., Kim, D., Lee, S. et al. Minimal-Scar Laparoscopic Adjustable Gastric Banding (LAGB). OBES SURG 19, 500–503 (2009).
42. Nozaki T, Ichimatsu K, Watanabe A, Komiya A, Fuse H. Longitu- dinal Incision of the Umbilicus for Laparoendoscopic Single Site Adrenalectomy: A Particular Intraumbilical Technique. Surg Lapa- rosc Endosc Percutan Tech 2010; 20: e185-e188
43. Compeau C, McLeod NT, Ternamian A. Laparoscopic entry: a re- view of Canadian general surgical practice. Can J Surg 2011; 54: 315-320.
44. Wang L, Cai C, Liu B, Yang Q, Wu Z, Xiao L, et al. Perioperative Out- comes and Cosmesis Analysis of Patients Undergoing Laparoen- doscopic Single-site Adrenalectomy: A Comparison of Transum- bilical, Transperitoneal Subcostal, and Retroperitoneal Subcostal Approaches . Urology 2013; 82: 358-364
45. Sinha R. Single-Incision Laparoscopic Transabdominal Preperi- toneal Inguinal Hernia Repair Using Only Conventional Instru- ments: An Initial Report. J Laparoendosc Adv Surg Tech A 2011;21: 335-340
46. Tsang T. The Scarless Umbilical Port Insertion (SUPI) Technique for Laparoscopic Surgery in Children Caroline Mary Smith.The_Scarless_Umbilical_Port_Insertion_SUPI_Technique_for_ Laparoscopic_Surgery_in_Children
47. S.F. Ngu, V.Y.T. Cheung, T.C. PunLeft upper quadrant approach in gynecologic laparoscopic surgery Acta Obstet Gynecol Scand, 90 (12) (2011), pp. 1406-1409
2. Jain N, Sareen S, Kanawa S, Jain V, Gupta S, Mann S. Jain point: A new safe portal for laparoscopic entry in previous surgery cases. Journal of Human Reproductive Sciences. 2016;9(1):9-17. doi:https://doi.org/10.4103/0974-1208.178637
3. Elbiss HM, Abu-Zidan FM. Bowel injury following gynecological laparoscopic surgery. African Health Sciences. 2018;17(4):1237. doi:https://doi.org/10.4314/ahs.v17i4.35
4. Tinelli A, Malvasi A, Mynbaev OA, et al. Bladeless Direct Optical Trocar Insertion in Laparoscopic Procedures on the Obese Patient. JSLS. 2013;17(4):521-528. doi:https://doi.org/10.4293/108680813x13693422519398.
5. Ashley SW, Maingot R, Zinner M, Mcgraw-Hill’S Accesssurgery. Maingot’s Abdominal Operations. Mcgraw Hill Medical, C; 2013.
6. Iranmanesh P, Morel P, Inan I, Hagen M. Choosing the cosmetically superior laparoscopic access to the abdomen: the importance of the umbilicus. Surgical Endoscopy. 2011;25(8):2578-2585. doi:https://doi.org/10.1007/s00464-011-1590-8
7. Rajkhowa K, Gogoi M, Baruah I. Periumbilical Incision VersusIntraumbilical Incision for Laparoscopic Appendectomy: A Randomized Comparative Study. Int J Sci Stud. (Int J Sci Stud 2016;4(8)):172-175.
8. Jun Yeob Lee, Tae Ho Hong, Kim JG. A comparison of the periumbilical incision and the intraumbilical incision in laparoscopic appendectomy. Journal of The Korean SurgicalSociety.2012;83(6):360-360. doi:https://doi.org/10.4174/jkss.2012.83.6.360
9. Jun Yeob Lee, Tae Ho Hong. Intraumbilical versus periumbilical incision in laparoscopic cholecystectomy: A randomized controlled trial. International Journal of Surgery. 2016;33:83-87. doi:https://doi.org/10.1016/j.ijsu.2016.07.071
10. T.H.HONG,H.L.Kim ,Y.S. Lee ,S.M.Park,trans-umbilical single port laparoscopic appendectomy:scarlessintracorporealappendectomy.j.laparoendoscAdvSurg Tech A 19 (2009)75- 78.
11. Piskun G, Rajpal S. Transumbilical Laparoscopic Cholecystectomy Utilizes No Incisions Outside the Umbilicus. Journal of Laparoendoscopic & Advanced Surgical Techniques. 1999;9(4):361-364. doi:https://doi.org/10.1089/lap.1999.9.361.
12. Jaschinski T, Mosch CG, Eikermann M, Neugebauer EA, Sauerland S. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database of Systematic Reviews.PublishedonlineNovember28,2018.doi:https://doi.org/10.1002/14651858.cd001546.pub4
13. Zollinger RM, Ellison EC, Zollinger RM. Zollinger’s Atlas of Surgical Operations. 9th ed. New York: McGraw-Hill Medical; 2011.
14. Bouffard-Cloutier A, Paré A, McFadden N. Periumbilical vs transumbilical laparoscopic incision: A patients’ satisfaction-centered randomised trial. International Journal of Surgery. 2017;43:86-91. doi:https://doi.org/10.1016/j.ijsu.2017.05.040
15. Tarpley, J. L.; Meier, D. A. Tropical Medicine for the General Surgeon. 2009. https://doi.org/10.1007/978-1-84628-833-3_192.
16. Golebiewski A, Losin M, Murawski M, Wiejec A, Lubacka D, Czaudema P. One, two or three port appendectomy – a rational approach. Wideochir Inne Tech Malo Inwazijne. 2013; 8(3):226-31.
17. wound healing and infection in subcutaneous closure techniques. B-ENT. 2009;5(3):149-152.
18. Lee, C L et al. “A new portal for gynecologic laparoscopy.” The Journal of the American Association of Gynecologic Laparoscopistsvol. 8,1 (2001): 147-50. doi:10.1016/s1074-3804(05)60565-8
19. KirankumarK., M et al. “TWO PORT LAPAROSCOPIC APPENDICECTOMY - AN ALTERNATIVE TO SILS AND NOTES.” Journal of Evolution of medical and Dental Sciences3 (2014): 6658-6662.
20. Hassler KR, Jones MW. Laparoscopic Cholecystectomy. [Updated 2020 Feb 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448145/
21. Azmat CE, Council M. Wound Closure Techniques. [Updated 2020 Jun 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470598/
22. Joshi, Deepa & Gajria, Kamal & Dixit, Sunny & Saroshe, Satish. (2016). A comparative study of subcuticular versus three mattress sutures for pfannenstiel skin closure in obstetrics and gynaecological surgeries. 3. 410-413. 10.18231/2394-2754.2016.0025.
23. LJ Draaijers, FR Tempelman, YA Botman, WE Tuinebreijer, E Middlekoop, RW Kreis, PP Van Zuijlen. The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. PlastReconstrSurg 2004 Jun; 113(7): 1960-5.
24. C Sharma , A Verma, A Soni, M Thusoo, VK Mahajan , S Verma. A randomized controlled trial comparing cosmetic outcome after skin closure with 'staples' or 'subcuticular sutures' in emergency cesarean section. Arch Gynecol Obstet. 2014 Oct;290(4):655-9.
25. Subcuticular versus mattress skin closure techniques following OBGYN laparotomies by low transverse incision. Akhila Vasudeva, Vidyashree G Poojari, Shanthala Rudrappa, Jyothi Shetty (e)-ISSN: 2250-3013, (p)-ISSN: 2319-4219 Volume 6, Issue 11 Version. 1 (Nov 2016), PP. 42-46.
26. MI Ibrahim , GF Moustafa, AS Al-Hamid ,MR Hussein . Superficial incisional surgical site infection rate after cesarean section in obese women: a randomized controlled trial of subcuticular versus interrupted skin suturing. Arch Gynecol Obstet. 2014 May;289(5):981-6
27. AD Mackeen, M Schuster ,V Berghella. Suture versus staples for skin closure after cesarean: a metaanalysis. Am J Obstet Gynecol. 2015 May;212 (5):621
28. Maingot's Abdominal Operations, 13e. Michael J. Zinner, Stanley W. Ashley, O. Joe Hines
29. Senturk, Mehmet Baki, et al. "Cosmetic outcomes of infraumbilical, supraumbilical, and transumbilical entry routes in laparoscopic surgery." Turkish Journal of Surgery, vol. 34, no. 4, 2018, p. 290+.
30. Fathi AH, Soltanian H, Saber AA. Surgical anatomy and morphologic variations of umbilical structures. Am Surg. 2012 May;78(5):540-4. PMID: 22546125.
31. Oh, Chang-Seok et al. “Morphologic variations of the umbilical ring, umbilical ligaments and ligamentum teres hepatis.” Yonsei medical journal vol. 49,6 (2008): 1004-7. doi:10.3349/ymj.2008.49.6.1004
32. Janosko EO, Jona JZ, Belin RP. Congenital anomalies of the umbilicus. Am Surg. 1977 Mar;43(3):177-85. PMID: 557306.
33. Hill, M.A. (2020, September 16) Embryology Book - Umbilicus (1916) 2
34. Yamamoto, M. et al. “Does Transumbilical Incision Influence Surgical Site Infection Rates of the Laparoscopic Sigmoidectomy and Anterior Resection?” The American Surgeon 81 (2015): 1232 - 1236.
35. Asakuma, M. et al. “A Concealed “Natural Orifice”: Umbilicus Anatomy for Minimally Invasive Surgery.” Surgical Innovation 26 (2019): 46 - 49.
36. Amarini, Rebekah et al. “Facilitation of Wound Healing Following Laparoscopic and Conventional Abdominal Surgery with Dressings, Patches, Antibiotics, etc.” (2019).
37. Dwivedy, Preshak et al. “Open Versus Laparoscopic Appendicectomy in a Tertiary Care Center – A Randomized Controlled Study.” (2020).
38. Sinha, Animesh and Buridi Kalyana Ramu. “A COMPARATIVE STUDY BETWEEN OPEN CHOLECYSTECTOMY AND LAPAROSCOPIC CHOLECYSTECTOMY IN RURAL MEDICAL COLLEGE SET UP.” Journal of Evolution of medical and Dental Sciences 3 (2014): 14663-14671.
39. Anderson, R. E. and J. Hunter. “Laparoscopic Cholecystectomy Is Less Expensive than Open Cholecystectomy.” Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 1 (1991): 82–84.
40. Reddy, B. V.. “Pain and Duration Scoring Between Open and Laparoscopic Cholecystectomy Dr.” (2016).
41. Kim, E., Kim, D., Lee, S. et al. Minimal-Scar Laparoscopic Adjustable Gastric Banding (LAGB). OBES SURG 19, 500–503 (2009).
42. Nozaki T, Ichimatsu K, Watanabe A, Komiya A, Fuse H. Longitu- dinal Incision of the Umbilicus for Laparoendoscopic Single Site Adrenalectomy: A Particular Intraumbilical Technique. Surg Lapa- rosc Endosc Percutan Tech 2010; 20: e185-e188
43. Compeau C, McLeod NT, Ternamian A. Laparoscopic entry: a re- view of Canadian general surgical practice. Can J Surg 2011; 54: 315-320.
44. Wang L, Cai C, Liu B, Yang Q, Wu Z, Xiao L, et al. Perioperative Out- comes and Cosmesis Analysis of Patients Undergoing Laparoen- doscopic Single-site Adrenalectomy: A Comparison of Transum- bilical, Transperitoneal Subcostal, and Retroperitoneal Subcostal Approaches . Urology 2013; 82: 358-364
45. Sinha R. Single-Incision Laparoscopic Transabdominal Preperi- toneal Inguinal Hernia Repair Using Only Conventional Instru- ments: An Initial Report. J Laparoendosc Adv Surg Tech A 2011;21: 335-340
46. Tsang T. The Scarless Umbilical Port Insertion (SUPI) Technique for Laparoscopic Surgery in Children Caroline Mary Smith.The_Scarless_Umbilical_Port_Insertion_SUPI_Technique_for_ Laparoscopic_Surgery_in_Children
47. S.F. Ngu, V.Y.T. Cheung, T.C. PunLeft upper quadrant approach in gynecologic laparoscopic surgery Acta Obstet Gynecol Scand, 90 (12) (2011), pp. 1406-1409