Extraction of gall bladder via umbilical port versus subxiphoid port for laparoscopic cholecystectomy in Pakistan: A systematic review and meta-analysis.

BACKGROUND

Gallbladder retrieval site in laparoscopic cholecystectomy (LC) may influence postoperative outcomes, yet there is limited consensus on the optimal port for extraction. This systematic review and meta-analysis aimed to compare the umbilical port (UP) versus epigastric/subxiphoid port (EP/SP) in terms of clinical efficacy and safety.

METHODS

This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed, Google Scholar, and the Cochrane Library was performed through June 2025. Only randomized controlled trials from Pakistan comparing EP and UP for LC were included. Outcomes assessed included postoperative pain at multiple intervals, retrieval time, port-site infection, and hospital stay. Data were synthesized using Review Manager (RevMan) 5.4.1 with random-effects models, and heterogeneity was assessed via I² statistics. Risk of bias was evaluated using Cochrane risk of bias (RoB 2.0).

RESULTS

Nine randomized controlled trials involving 1338 patients (672 EP, 666 UP) were analyzed. UP retrieval was associated with significantly lower postoperative pain at 1, 6, 24, and 48 hours. Retrieval time was shorter in the UP group (mean difference: -1.34 minutes; 95% confidence interval: -2.40 to -0.28; P = .01). Hospital stay was also reduced with UP (mean difference: -0.73 days; 95% confidence interval: -1.31 to -0.16; P = .01). Port-site infection rates showed no significant difference (risk ratio = 1.23; P = .90). Sensitivity analyses supported the robustness of key findings.

CONCLUSION

UP retrieval in LC offers favorable early postoperative outcomes, including reduced pain and shorter hospital stay, compared to the subxiphoid port. These results support UP as a potentially preferred approach.