Umbilical port versus epigastric port for gallbladder extraction in laparoscopic cholecystectomy. An updated systematic review and meta-analysis

Abstract

Laparoscopic cholecystectomy (LC) is the gold standard for gallstone disease, but the optimal extraction port (umbilical vs. epigastric) remains debated. This updated systematic review and meta-analysis aimed to evaluate whether port site selection impacts perioperative and postoperative outcomes in LC, specifically comparing their effectiveness regarding pain, operative time, and complications. Following PRISMA 2020, PubMed, Embase, Scopus, Google Scholar, and Cochrane Library were searched to August 2025. Randomized controlled trials comparing umbilical and epigastric extraction in LC were analyzed. The primary outcome was 24-hour postoperative pain (VAS); secondary outcomes included operative time, retrieval time, infection, and hernia. Sixteen RCTs ( n = 1415) were included. No significant differences were observed in pain (MD -0.59, 95% CI -1.53 to 0.35, P = 0.22), retrieval time (MD 0.09; 95% CI: -0.87 to 1.04; P = 0.60), infection (RR 0.97; 95% CI: 0.50 to 1.89; P = 0.87), or hernia (RR 1.78; 95% CI: 0.81 to 3.93; P = 0.10). Epigastric extraction showed a nonsignificant trend toward shorter operative time (MD 2.59; 95% CI: -0.17 to 5.35; P = 0.07). TSA indicated that the cumulative Z-score crosses neither the superiority nor the futility boundary; thus, the evidence is considered insufficient, and more trials are needed. Umbilical and epigastric ports provide comparable results, though epigastric extraction may slightly reduce operative time. Larger RCTs with standardized methods and long-term follow-up are warranted.