A Randomised Controlled Study to Reduce the Incidence of Umbilical Port Site Complications in Laparoscopic Cholecystectomy Using Uniform Methods of Umbilical Hygiene

Abstract

Port site infection causes significant morbidity in patients undergoing laparoscopic cholecystectomy. The umbilicus, the most common location for creating pneumoperitoneum, frequently harbours resident microflora, which can render a patient susceptible to subsequent port site infections. Umbilical hygiene and its role in preventing surgical site infections have not yet been studied. Our study aimed to bridge this gap by proposing a method for umbilical hygiene. Five hundred two patients planned for laparoscopic cholecystectomy were randomised. In the intervention arm, the umbilicus was cleaned with 2–3 drops of coconut oil and patients were instructed to take a bath, with an emphasis on umbilicus cleaning. Patients in the control group were asked to bathe before surgery, without applying coconut oil. In both arms, the abdomen was painted using chlorhexidine, and a standard laparoscopic cholecystectomy was done with the gall bladder being extracted through the epigastric port. Eight (or 1.5%) of the 480 patients had port site infections. Five of them had infections at the umbilical port site, of which four (p = 0.200) belonged to the control group. Our study showed no statistically significant association between preoperative umbilical hygiene and port site infection. This might be due to the fact that patients in both arms bathed prior to the surgery and had their abdomen painted and deep cleaned with chlorhexidine. Hence, we would like to emphasise the significance of deep cleaning of the umbilicus with chlorhexidine during the painting of the abdomen. Further studies with a larger sample size are needed.