There has been continuous advancement in healthcare with the goal of reducing morbidity, complications, and ensuring quicker recovery through surgical interventions1,2. Laparoscopic or minimal access surgery has revolutionized this effort by allowing procedures through small skin incisions (ports) using trocars, telescopes, and specialized instruments. This approach leads to significantly reduced postoperative pain, quicker patient recovery3, and shorter hospital stays. However, the increasing volume and complexity of laparoscopic procedures have introduced complications, particularly those related to abdominal access via trocars4. These include vascular and visceral injuries, subcutaneous emphysema, port site infections (PSIs), and even rare conditions such as pyoderma gangrenosum and port-site metastasis in oncologic surgeries5. Though precise incidence data is limited, studies suggest laparoscopic cholecystectomy accounts for most PSIs6, especially at the epigastric port, with Mycobacterium chelonae being the most commonly isolated organism. Inadequate disinfection with 2% glutaraldehyde and patient-related factors such as diabetes, hypoalbuminemia, hematologic malignancies, and leukopenia are recognized contributors to these infections7-9.

Many Non-Tuberculous Mycobacterium (NTM) port-site infections have emerged over the past decade10, although exact incidence rates remain unclear, with reported frequencies ranging from 1%–8% depending on surgery type and site. While most cases have been documented in India, Wright et al. (2014) also reported 18 NTM infections linked to laparoscopic gastric banding in Australia11. Research indicates that diabetes significantly increases the risk of surgical site infections; for instance, patients with preoperative HbA1c >7.0% had a 35.3% infection rate in spinal surgery versus 0% in those with lower HbA1c12,13. Additionally, perioperative hyperglycaemia (>200 mg/dL) is an independent predictor of surgical site infections, increasing risk over threefold. In laparoscopic cholecystectomy, bacteriobilia was associated with a significantly higher port site infection rate (16% vs. 2%; p=0.018), with common organisms being E. coli, Klebsiella, Pseudomonas, and other gram-negative rods14. These findings highlight the microbial causes of infection15, but few studies have comprehensively explored host-related risk factors like diabetes, immune status, or nutritional deficiencies. Hence, further investigation is warranted to understand and mitigate non-microbial contributors to port-site infections16.

AIM

To determine the prevalence of port site complication in laparoscopic surgery

The present study was a hospital-based prospective study conducted in the Department of General Surgery at Mahatma Gandhi Medical College & Hospital (MGMC&H), Jaipur. The study was carried out over a period of 18 months, from September 2022 to March 2024. Patients included in the study were those aged between 18 and 65 years who were fit for surgery and had undergone either basic or advanced laparoscopic procedures at MGMC&H, Jaipur, with informed consent for participation. Exclusion criteria comprised patients unfit for general anaesthesia, those who did not provide consent, and patients in whom laparoscopic procedures were converted to open surgeries.

Table 1. Distribution based on Age

The age distribution of study subject with mean age to be 48.04 yrs (SD 11.366). Majority belong to age group 51-60 yrs (43%) with minimum age to be 18 years and maximum age to be 65 yrs.

Table 2. Distribution on basis of Gender

The distribution of study subjects according to gender in which out of 100 patients, 58 were female and 42 were male with female to male ratio being 1.38.

Table 3. Distribution according to BMI

Majority of the patients were of normal BMI (71%), and 22% were pre-obese and 7% were obese. Mean BMI was 23.24 with 3.28 SD. Minimum BMI was 18.14 and maximum 37.88.

Table 4. Distribution according to Co-morbidities

Majority of the patients i.e 81% had no co-morbidities, followed by 11% who had diabetes, and 8% who had hypertension.

Table 5. Distribution according to WBC Count

WBC count of the study subject with 36% (36) having WBC count <10,000 and 64% (64) having WBC count >10000 with mean WBC count 10650 (SD 2065) and range 721 to18221.

Table 6. Distribution according to type of laparoscopic surgery

The distribution of study subjects according to type of laparoscopic surgery. In the study most patients underwent laparoscopic cholecystectomy (39%), followed by laparoscopic hernia repair (22%), laparoscopic appendicectomy (19%), diagnostic laparoscopy (8%), laparoscopic fundoplication (4%), laparoscopic ovarian cystectomy (4%), total laparoscopic hysterectomy (2%), and laparoscopic rectopexy (2%).

Table 7. Distribution according to Complications

Majority of patients i.e 96% had no complications. Hernia, infection and bleeding were the complications in 1%, 2% and 1% of the patients, respectively.

Table 8. Distribution according to Port Size

Both 10 mm and 5 mm ports were used in 100% of the study population undergoing laparoscopic surgery.

Open surgeries were done routinely earlier, and those surgeries were performed by making a large (8 cm -10 cm) incision into the abdomen to expose the area inside, where the intervention is to be done. Resulting in a comparatively more post-operative pain due to the large incision, these kinds of surgeries often need a longer hospital stay (5-7 days) until a satisfactory wound healing and recovery takes place. In some cases, patients have to rest for up to six weeks before returning to routine activities and occupation due to several possible negative outcomes like infections and breaking of sutures. Moreover, open surgery also has a higher risk of adhesion formation, wound infections, and incisional hernias due to its wide exposure of tissues to external environment. However, these types of surgeries are still carried out in some cancer operations and huge pelvic masses.

To remove the complications of open surgeries, laparoscopic surgeries are now performed which is basically a ‘keyhole surgery’. We know that laparoscopic surgery is usually performed by making a ½-1 cm incision, where a flexible tube attached to a camera and light source is inserted into the abdomen. The surgeon will see the whole inside-scenario on a monitor, where handling of instruments inside will be done by a visual guided procedure which requires a highly specialised training. It has many benefits compared to open surgery as these types of surgeries do not require large incisions which is safe and effective compared to that of open surgery. Minimal pain, early return to normal day today activities, minimally visible scarring, lesser risk of wound infections, lesser adhesion formation and lesser incisional hernias are the main benefits leading to replacing of open surgeries by laparoscopic surgeries.1

In this study, 100 patients were included. 2% of the study subjects belonged to age group 11 to 20 yrs, 9% of the study subject belonged to age group 21 to 30 yrs, 19% of the study subjects belonged to age group 31 to 40 yrs, 18% of the study subjects belonged to age group 41 to 50 yrs, 43% of the study subjects belonged to age group 51 to 60 yrs, and 9% of the study subjects belonged to age group 61 to 70 yrs. Hence, majority of the study subjects, i.e 43%, belonged to the age group of 51 to 60 years. Maximum age of study subjects was 65 yrs, and minimum age was 18 yrs with mean age to be 48.04 yrs.

In this study, out of total 100 study subjects, 42% were males and 58% were females, with female to male ratio being 1.38. Hence, in our study females were more that males. In the present study, majority of the patients, i.e 71% (71), were of normal BMI (71%), followed by 22% (22) as pre-obese, and rest 7% (7) were obese. Mean BMI was 23.24, with 3.28 SD. Minimum BMI was 18.14 and maximum was 37.88. Among the study subject, 81% (81) had no co-morbidities, 11% (11) were suffering from diabetes, and 8% were suffering from hypertension.

In this study 36% (36) patients were having WBC count <10,000, and 64% (64) patients having

WBC count >10,000 with mean WBC count 10,650 (SD 2065) and range 721 to 18,221.

In our study, 39 % of the study subjects underwent laparoscopic cholecystectomy, 22% underwent laparoscopic hernia repair, 19% underwent laparoscopic appendicectomy, 8% underwent diagnostic laparoscopy, 4% underwent laparoscopic fundoplication, 4% underwent laparoscopic ovarian cystectomy, and 2% underwent total laparoscopic hysterectomy. So, majority of the study subjects, i.e 39, underwent laparoscopic cholecystectomy, and only 2% of study subjects underwent total laparoscopic hysterectomy. In a similar study done by Kumar et al17, Laparoscopic cholecystectomy was the most performed procedure (66.39%), followed by laparoscopic appendicectomy (18.89%), diagnostic laparoscopy (8.89%), and laparoscopic hernia repair (5.83%). A similar study by Singh et all3 showed laparoscopic surgery for cholelithiasis was the the most common procedure done in 92.58% (287) of the study subjects followed by laparoscopic surgery for appendicitis (9%), laparoscopic umblical hernia repair and left inguinal hernia (2%), right inguinal hernia (2%) etc. In a similar study done by Kartik et al18, laparoscopic cholecystectomy was the most common procedure done in 37.9% (216) subjects followed by laparoscopic appendicectomy (30.4%), laparoscopic TEP (15.3%), hernioplasty (1.8%), rectopexy (7%) and diagnostic laparoscopy (9.6%).

Thus, on comparing, we found that the most common laparoscopic surgery performed is laparoscopic cholecystectomy in most of the studies and this finding is depicted in our study also with 39% of the study subjects having undergone laparoscopic cholecystectomy. According to Dr Aloy J Mukherjee19, laparoscopic cholecystectomy is the most common surgical procedure performed in the world today and that is consistent in our study also.

In the present study 96% (96) of the study subjects did not suffer from any complications. But 1% (1) of the study population developed hernia, 2% (2) had infections, and 1% (1) experienced bleeding from port sites. In the study by Singh et al20, port site infection was observed in 1.94% (6) of cases, while metastasis and hypertrophied scar were each reported in 0.32% (1) of cases. Notably, 97.42% (332) of patients experienced no complications. In contrast, the study by Karthik et al.18 reported a higher incidence of complications, with port site infection seen in 10 cases, bleeding in 4 cases, hernia and omental trapping in 1 case each, and port site metastasis also in 1 case. These findings highlight the variability in post-laparoscopic complications across different studies.

In this study, laparoscopic cholecystectomy was the most commonly performed procedure, reflecting global surgical trends. The majority of patients were aged between 51 to 60 years, and females outnumbered males. Most participants had a normal BMI and no comorbidities, though diabetes and hypertension were present in some. Postoperative complications were minimal, with only 4% of patients experiencing issues such as infection, hernia, or bleeding. These findings support the safety, efficacy, and low complication rate of laparoscopic surgeries compared to open procedures.

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