Umbilical incision extension for large gallstone extraction during laparoscopic cholecystectomy: A randomized controlled trial

BACKGROUNDLaparoscopic cholecystectomy (LC) is the gold standard for treating benign gallbladder diseases.With advances in laparoscopic technology, a previous study showed that, compared with gallbladder removal through a subxiphoid incision, removal through an umbilical incision reduces early postoperative pain without increasing the risk of complications.However, there are no clear guidelines regarding methods for removing large stones.This randomized controlled trial evaluated the impact of extending vs not extending the umbilical incision during LC for gallbladder removal on perioperative outcomes. AIMTo evaluate the impact of extending vs not extending the umbilical incision for gallbladder removal during LC on perioperative outcomes. METHODSFrom July 2024 to November 2025, patients who met the inclusion criteria were randomly assigned to two groups.Perioperative data were recorded and compared between the groups. RESULTSA total of 157 patients were included in the analysis.The extended incision group included 79 patients, whereas the nonextended incision group included 78 patients.Gallbladder specimen retrieval time was shorter in the extended incision group (190.86 ± 186.79 seconds) than in the nonextended incision group (372.09± 310.05 seconds, P < 0.001).Total operative time was also shorter in the extended incision group (50.01 ± 18.09 minutes vs 56.73 ± 19.18 minutes, P = 0.025).However, there were no statistically 4 / 37 significant differences between the groups in postoperative pain scores at multiple time points, analgesic use, incision scar scores at 30 days, complication rates, or changes in gastrointestinal quality of life. CONCLUSIONIn patients with gallstones ≥ 20 mm in diameter, moderate extension of the umbilical incision (average, 11 mm) can significantly reduce gallbladder specimen retrieval time and total operative time.However, it does not increase postoperative pain, analgesic demand, or pain duration, nor does it affect the risk of incision scar formation, postoperative complication rates, or recovery of gastrointestinal quality of life within 30 days postoperatively.