Avoiding the Umbilical Incision in Obese Patients Undergoing Laparoscopic Cholecystectomy: A Retrospective Cohort Study of Wound-Related Outcomes

Abstract

Background:

The umbilical port is routinely used for camera insertion and specimen retrieval in laparoscopic cholecystectomy (LC). However, the umbilicus is anatomically vulnerable and may be associated with an increased risk of surgical site infection (SSI) and port-site hernia (PSH), particularly in obese patients. We evaluated the clinical impact of avoiding an umbilical incision in obese patients undergoing LC.

Methods:

This single-center retrospective cohort study included 75 patients with a body mass index (BMI) ≥ 32 who underwent LC between April 2019 and November 2025. Patients were divided into an umbilical incision group (n = 46) and a nonumbilical incision group (n = 29). The primary endpoint was overall postoperative complications (Clavien–Dindo grade ≥ II) within 6 months. Absolute risk differences and corrected odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results:

Postoperative complications occurred in six patients (12.8%) in the umbilical incision group and in none (0%) in the nonumbilical incision group (P = .076). Although the difference did not reach statistical significance, all observed complications occurred in the umbilical incision group. The absolute risk difference was 13.0% (95% CI 3.3%–22.8%). After Haldane–Anscombe correction, the estimated OR for complications associated with the umbilical incision approach was 9.47 (95% CI 0.51–174.76). All complications were wound-related (four SSIs and two PSHs). Operative time, blood loss, and postoperative hospital stay were significantly lower in the nonumbilical incision group. All outcome measures consistently favored the nonumbilical approach.

Conclusions:

Although statistical significance was not reached, all wound-related complications occurred exclusively in the umbilical incision group. Avoiding an umbilical incision in obese patients undergoing LC may represent a clinically reasonable strategy associated with a potential reduction in wound-related morbidity. Larger prospective studies are warranted.