Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.118264
Revised: January 31, 2026
Accepted: March 6, 2026
Published online: May 27, 2026
Processing time: 150 Days and 18.6 Hours
Laparoscopic cholecystectomy (LC) is widely accepted as the standard surgical treatment for gallbladder diseases due to its advantages: Reduced postoperative pain, shorter hospital stay, and faster recovery. Despite these benefits, port-site-related complications remain a crucial clinical issue. The umbilicus is commonly used for initial access to the peritoneal cavity; however, its anatomical structure predisposes it to bacterial colonization, raising concerns regarding surgical site infection and incisional hernia, particularly when a transumbilical incision is used. Although transumbilical access offers shorter operative time and superior cosmetic outcomes, its safety remains debated as standard preoperative skin preparation may not adequately eliminate umbilical microflora. Evidence regar
To compare operative time, surgical site infection, length of hospital stay, post
This prospective randomized controlled study was conducted at a tertiary-level university hospital. Patients aged ≥ 18 years who were scheduled for elective LC and met the inclusion criteria were enrolled. In total, 88 patients were assessed, and 80 patients who completed follow-up were randomized into two equal groups. In the intervention group, preoperative umbilical care with chlorhexidine gluconate was applied twice (once 6 hours before surgery and once immediately before skin preparation); trocar entry was performed via a transumbilical incision. In the control group, standard skin preparation was applied, and trocar entry was achieved through a periumbilical incision. The operative time, surgical site infection, the length of hospital stay, cosmetic satisfaction, scar healing, and incisional hernia were evaluated. Cosmetic satisfaction was assessed using a visual analog scale and scar quality using the patient and observer scar assessment scale. Patients were followed during hospitalization and reassessed at the first postoperative month.
Baseline demographic and clinical characteristics were similar between the two groups. No significant differences were observed in surgical site infection rates, the length of hospital stay, or incisional hernia occurrence between groups. Operative time was significantly shorter in the transumbilical incision group. Postoperative cosmetic satisfaction scores were significantly higher in patients who had a transumbilical incision. Patient- and observer-reported scar assessment scores demonstrated significantly better scar healing outcomes in the transumbilical incision group.
Transumbilical access combined with appropriate preoperative umbilical care can be safely used in LC. This approach offers complication rates comparable to the periumbilical technique, with the advantages of shorter operative time, improved scar quality, and higher postoperative cosmetic satisfaction.
Core Tip: Port-site selection and preoperative umbilical preparation are crucial but insufficiently addressed determinants of laparoscopic cholecystectomy outcomes. In this prospective randomized study, transumbilical access combined with targeted umbilical care using chlorhexidine gluconate shortened operative time while improving postoperative cosmetic satisfaction and scar healing. This approach did not increase the rates of surgical site infection or incisional hernia compared with standard periumbilical access. These findings indicate that meticulous umbilical care enables safe transumbilical entry and offers a simple, low-cost strategy to enhance surgical efficiency and patient-centered outcomes in routine laparoscopic cholecystectomy.