Evaluation of Outcomes of Supraumbilical Versus Infraumbilical Primary Port Placement for Laparoscopic Access among Comorbid Patients in A Tertiary Care Hospital of Bangladesh

Background: Optimal primary port placement remains debated in laparoscopic surgery, particularly for comorbid patients. This study compared outcomes of supraumbilical versus infraumbilical port placement in comorbid patients at a tertiary care hospital in Bangladesh. Methods: Prospective randomized controlled trial of 70 comorbid patients undergoing elective laparoscopic procedures. Patients were randomized to supraumbilical (n=35) or infraumbilical (n=35) primary port placement. Primary outcomes included time to pneumoperitoneum, insertion success rates, and access-related complications. Secondary outcomes assessed visualization quality, operative time, postoperative pain, and patient satisfaction, delayed outcome measures were evaluated included - Incidence of port site herniation, Port site infection, cosmetic out comes. Results: Infraumbilical placement achieved significantly faster pneumoperitoneum establishment (3.6±1.4 vs 4.2±1.8 minutes, p=0.038) and higher first-attempt success rates (91.4% vs 74.3%, p=0.045). Trocar insertion was easier with infraumbilical approach (p=0.032) with superior visualization quality (74.3% vs 51.4% excellent rating, p=0.041). Access-related complications were numerically lower in infraumbilical group (8.6% vs 22.9%, p=0.092). Incidence of port site herniation (5% vs. 0%), port site infection (8.6% vs. 2.9%) were numerically lower in infraumbilical port placement. Excellent port site cosmetic out comes (34.3% vs. 57%) infraumbilical group. No significant differences occurred in operative time, postoperative pain, hospital stay, or patient satisfaction between groups. Conclusion: Infraumbilical primary port placement offers superior technical outcomes compared to supraumbilical approach in comorbid patients, with faster pneumoperitoneum establishment, higher success rates, and better visualization quality while maintaining comparable safety profiles. Less chance of port site herniation with much lower rates of port site infection