Comparison between the Retrieval of the Gallbladder by the Direct Extraction Method and the Bag Method in Laparoscopic Cholecystectomy
DOI:
https://doi.org/10.51985/Keywords:
bile spillage, gallbladder removal, laporoscopic cholecystectomy, port site infection, specimen bagAbstract
Abstract
Objective: This study aimed to compare the complications associated with direct versus endobag retrieval methods in laparoscopic cholecystectomy.
Study design and setting: A prospective cohort study was conducted at PNS Shifa Hospital, Karachi, from 1st June 2024 to 30th June 2025.
Methodology: A total of 270 patients with ultrasound-proven cholelithiasis undergoing laparoscopic cholecystectomy were included. Patients were divided into two groups: Group A (direct retrieval, n=114) and Group B (Endo bag retrieval, n=156). Postoperative complications, including port-site pain, infection, hernia, sinus formation, and intraperitoneal contamination, were assessed and statistically analyzed using SPSS v21.
Results Direct retrieval was associated with significantly higher intraperitoneal contamination (15% vs. 5.6%, p<0.05). Endo bag retrieval showed a higher rate of port-site pain (14.5% vs. 22.3%). Rates of surgical site infection and port-site hernia were comparable between both groups.
Conclusion Endo bag use significantly reduced intraperitoneal contamination and stone spillage. However, it increased postoperative port-site pain due to larger fascial incisions. Direct retrieval remains cost-effective but carries higher contamination risk. Choice of retrieval technique should balance patient safety, surgical outcomes, and resource availability. Keywords: bile spillage, gallbladder removal, laporoscopic cholecystectomy, port site infection, specimen bag
References
1. Jones MW, Small K, Kashyap S, Deppen JG. Physiology,
gallbladder. InStatPearls 2023 May 1. StatPearls Publishing
https:// www.ncbi.nlm.nih.gov/books/NBK482488/
2. Ahmed N, Raha MS, Seth US, Kamal MT, Al AN, Wyne A.
Frequency of Port Site Wound Infection with and Without
End Gloves Techniques of Retrieval of Gallbladder in Pouch.
Pakistan Journal of Medical & Health Sciences [Internet].
2021 Dec 10;15(12):3399–401. https://doi.org/10.53350
/pjmhs2115123399
3. https://emedicine.medscape.com/article/175667-overview#a1
4. Prra-Landazury NM, Cordova-Gallardo J, Méndez-Sánchez
N. Obesity and Gallstones. Visc Med. 2021 Oct;37(5):394-
402. Epub 2021 Apr 23. https://doi.org/10.1159/000515545
5. Aqsa Nasir et al (2021). Prevalence of Gallstone disease and
its correlation with Age among people undergoing Abdominal
Ultrasound in Gujranwala. EAS J Radiol Imaging Technol,
3(3), 142-145. DOI:10.36349/easjrit.2021.v03i03.004
6. Weerakoon H, Vithanage I, Alahakoon O, Weerakoon K.
Clinico-epidemiology and aetiopathogenesis of gallstone
disease in the South Asian region: a scoping review protocol.
BMJ Open. 2022 Jun 13;12(6):e057808. 057808. DOI:10.
1136/bmjopen-2021-
7. Divya Upadhyay N, Goel VK, Shekhar H, Tiwari N.
Comparative study of port site complication in laparoscopic
cholecystectomy after gall bladder retrieval using indigenous
drain bag or direct extraction. Int J Acad Med Pharm.
2024;6(4):812- DOI:10.47009/jamp.2024.6.4.160
8. Mohamed HK, Albendary M, Wuheb AA, Ali O, Mohammed
MJ, Osman M, Elshikhawoda MS, Mohamedahmed AY,
MOHAMED HK, Ali O, MOHAMMED MJ. A systematic
review and meta-analysis of bag extraction versus direct
extraction for retrieval of gallbladder after laparoscopic
cholecystectomy. Cureus. 2023 Feb 26;15(2). DOI:10.7759
/cureus.35493
9. Demirbas BT, Gulluoglu BM, Aktan AO: Retained abdominal
gallstones after laparoscopic cholecystectomy: a systematic
review. Surg Laparosc Endosc Percutan Tech. 2015, 25:97-
99. DOI: 10.1097/SLE.000000000000010510. Laparoscopic Cholecystectomy in Acute Cholecystitis: An
Updated Review.”Asian Journal of Medicine and Health, vol.
22, no. 6, 2024, pp. 160-167. DOI:10.9734/ajmah/2024/
v22i61033
11. Amin, R., Ovi, M. R. A., & Nasrin, S. (2023). Outcome of
spillage of gallbladder contents during laparoscopic
cholecystectomy: a case control study. International Surgery
Journal, 11(1), 45–52. https://doi.org/10.18203/2349-
2902.isj20233921
12. Singh K, Walia DS, Singla A, Banal A, Jangir N. A comparison
of the benefits and complications of the extraction of the
gallbladder in an endobag using a drain bag versus direct
extraction. Indian Journal of Anatomy, Radiology and Surgery.
2018 Jan;7(1):SO13–SO18 DOI:10.7860/IJARS/2018/
32069:2356
13. Zehetner J, Shamiyeh A, Wayand W. Lost gallstones in
laparoscopic cholecystectomy: all possible complications.
Am J Surg. 2007;193:73-78. DOI:10.1016/j.amjsurg.2006.
05.015
14. Nida Mumtaz, Ali Hasnain Malik, Sana Ullah Khan, Abdullah
Khan, Maleeha Nisar, & Shoaib Muhammad. (2023).
Comparison of gall bladder removal with and without endobag
during laparoscopic cholecystectomy in term of port site
infection. Journal of Population Therapeutics and Clinical
Pharmacology, 30(18), 2750-2756. https://doi.org/10.53555
/jptcp.v30i18.3533
15. Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ.
Laparoscopic versus small-incision cholecystectomy for
patients with symptomatic cholecystolithiasis. Cochrane
Database Syst Rev. 2006 Oct 18;2006(4): CD006229. DOI:
10.1002/14651858.CD006229
16. Elangovan S, Subramania Nathan Kv, Sivamarieswaran R, Jose
Mr. Direct Gallbladder Extraction versus Endobag Extraction
during Laparoscopic Cholecystectomy: A Prospective
Observational Study. Journal of Clinical & Diagnostic
Research. 2025 Aug 1;19(8). DOI: 10.7860/JCDR/2025/
79293.21325
17. Mannam R, Sankara Narayanan R, Bansal A, Yanamaladoddi
VR, Sarvepalli SS, Vemula SL, Aramadaka S. Laparoscopic
Cholecystectomy Versus Open Cholecystectomy in Acute
Cholecystitis: A Literature Review. Cureus. 2023 Sep
21;15(9):e45704. DOI:10.7759/cureus.45704
18. Lazarchuk I, Barzak B, Wozniak S, Mielczarek A, Lazarchuk
V. Cholelithiasis–a particular threat to women. A review of
risk factors. Medical Journal of Cell Biology. 2023;11(1):20-
7 DOI: 10.2478/acb-2023-0003
19. Martin WT, Stewart K, Sarwar Z, Kennedy R, Quang C,
Albrecht R, Cross A. Clinical diagnosis of cholecystitis in
emergency department patients with cholelithiasis is indication
for urgent cholecystectomy: A comparison of clinical,
ultrasound, and pathologic diagnosis. The American Journal
of Surgery. 2022 Jul 1;224(1):80-4. https://doi.org/10.1016/
j.amjsurg.2022.02.051
20. Sakorafas GH, Milingos D, Peros G. Asymptomatic
cholelithiasis: is cholecystectomy really needed? A critical
reappraisal 15 years after the introduction of laparoscopic
cholecystectomy. Dig Dis Sci. 2007 May;52(5):1313-25.
DOI:10.1007/s10620-006-9107-3
21. Lee BJH, Yap QV, Low JK, Chan YH, Shelat VG.
Cholecystectomy for asymptomatic gallstones: Markov
decision tree analysis. World J Clin Cases. 2022 Oct
16;10(29):10399-10412. DOI:10.12998/wjcc.v10.i29.10399
22. Huynh R, Magdy M, Saliba L, Loi K. Retained gallbladder
secondary to retrieval bag rupture during laparoscopic
cholecystectomy-A case report. Int J Surg Case Rep.
2019;59:101-106. DOI:10.1016/j.ijscr.2019.04.052.
23. Kafadar MT, Çetinkaya I, Aday U, Baºol Ö, Bilge H. Acute
abdomen due to spilled gallstones: a diagnostic dilemma 10
years after laparoscopic cholecystectomy. Journal of Surgical
Case Reports. 2020 Aug 1;2020(8). https://doi.org/10.1093/
jscr/rjaa275
24. Faridi S, Siddiqui B, Harris H, Hussain D, Mittal S, Habib
Faridi S. Chronic Port Site discharging sinus following
Laparoscopic Cholecystectomy: An experience of 5 years at
a tertiary health care centre. International Journal of Human
a n d H e a l t h S c i e n c e s ( I J H H S ) . 2 0 2 3 M a y
http://dx.doi.org/10.31344/ijhhs.v7i700.547
25. Begum S, Khan MR, Gill R. Cost effectiveness of glove
endobag in laparoscopic cholecystectomy: Review of the
available literatur. The Journal of the Pakistan Medical
Association. 2019;69(Supl. 1):S58. https://ecommons.aku.
edu/pakistan_fhs_mc_surg_surg/769
26. Memon J, Memon M, Arija D, Gohar Bozdar A, Muhammad
M, Talpur A. Retrieval of gallbladder through epigastric port
as compared to umbilical port after laparoscopic
cholecystectomy. Pak J Pharm Sci. 2014;27(6):2165–8.
27. Qassem, Mohamed G.; Albalkiny, Sherif; Behairy, Gad M.
Endobag extraction versus direct extraction of gall bladder
specimen during laparoscopic cholecystectomy: is routine
usage of endobag mandatory? A prospective cohort study.
The Egyptian Journal of Surgery 40(2): p 585-593, Apr–Jun
2021 DOI: https://doi.org/10.4103/ejs.ejs_34_21
28. Makhsosi B R, Azadmehr A, Rezaei, M A, Salimi M, Darabi
B. The Effect of Endo-bag on Postoperative Complications
in Laparoscopic Cholecystectomy Surgery. Tabari Biomed
Stu Res J. 2024;6(2):10-16. DOI: https://doi.org/10.22034/
6.2.10
29. Zehetner J, Shamiyeh A, Wayand W. Lost gallstones in
laparoscopic cholecystectomy: all possible complications.
Am J Surg. 2007;193:73-78. DOI:10.1016/j.amjsurg.
2006.05.015
30. Raj PK, Katris F, Linderman CG, ReMine SG. An inexpensive
laparoscopic specimen retrieval bag. Surg Endosc. 1998
Jan;12(1):83. DOI: 10.1007/s004649900601
31. Singhal S, Jain AP, Prajapati AJ, Jain PA. Our experience of
laproscopic cholecystectomy with associated complications
and their treatment: a study of 200 cases. Int Surg J
2024;11:1808-14. DOI: https://doi.org/10.18203/2349-
2902.isj20243233
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0
