Trial reportLangenbeck's archives of surgery2025
Safe access to laparoscopic cholecystectomy in patients with previous periumbilical incsions: new approach to avoid entry related bowel injury.
Trial report in Langenbeck's archives of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- An international multidisciplinary consensus statement on laparoscopic liver biopsy.Cell reports. Medicine · 2026Article
- Feasibility of Vibroacoustic Sensing for Detection of Peritoneal Entry During Laparoscopic Access: A Pilot Study in a Human Body Donor.Diagnostics (Basel, Switzerland) · 2026Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPatients with prior abdominal surgeries are at higher risk of intra-peritoneal adhesions near the trocar entry site, increasing the likelihood of organ injury during laparoscopic cholecystectomy (LC). This study evaluates a novel technique where the epigastric trocar is inserted first, after creating pneumoperitoneum, to allow safe dissection of adhesions under direct vision before placing the umbilical trocar.
methodsThis prospective study included 244 patients with symptomatic uncomplicated gallstone disease and a history of previous abdominal surgeries extending to the umbilicus. Patients were randomly assigned to two groups: Group I (n = 98) underwent traditional umbilical trocar-first LC using the Hasson technique, while Group II (n = 146) received LC using the epigastric trocar-first approach. Operative time, complications, and conversion rates were analyzed.
resultsThere was no significant difference in the demographics between both groups. The epigastric trocar-first approach significantly reduced total operative time (41.6 ± 7.7 min vs. 46.8 ± 8.8 min, p = 0.031) and small bowel injury rates (p = 0.006). Otherwise, intraoperative complications were comparable. Conversion to open surgery was lower in Group II (2.1% vs. 8.2%, p = 0.012). Postoperative pain at 6 h was significantly lower in Group II (p = 0.001).
conclusionsThe epigastric trocar-first approach, offers a safer alternative for patients with prior abdominal surgeries when undergoing LC. This approach is safe; minimizes bowel injury risk, reduces conversion rates, and enhances patient recovery. This approach may also be beneficial in other laparoscopic procedures requiring safe entry in patients with prior abdominal surgeries. Further studies are recommended to validate its broader clinical application.
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