A Comparative Study on Benefits and Complications of Removal of Gallbladder with or without Retrieval Bags During Laparoscopic Cholecystectomy

Author's Information:

Dr. Prakriti Bhattarai

Bhaktapur Hospital, Bhaktapur, Nepal 

Dr. Kishor Manandhar

National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

Dr. Isha Dahal

National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

Dr. Sakar Raj Sitaula

B&B Hospital, Gwarko, Kathmandu, Nepal

Vol 06 No 04 (2026):Volume 06 Issue 04 April 2026

Page No.: 111-114

Abstract:

Laparoscopic cholecystectomy is one of the most commonly performed surgical procedures worldwide; however, specimen retrieval remains a critical step associated with potential complications such as surgical site infection, bile spillage, and port site hernia. The use of retrieval bags during gallbladder extraction is based on surgeon preference and resource availability. This study aimed to compare the benefits and complications of using retrieval bags versus direct extraction during laparoscopic cholecystectomy. A hospital-based prospective comparative study was conducted among 120 patients undergoing laparoscopic cholecystectomy. Participants were divided into two groups: retrieval bag used (n=60) and not used (n=60). Outcomes assessed included surgical site infection, postoperative pain and recovery parameters. The mean age of the patients was 44.0+/-13.0years, with a female predominance (4:1). Surgical site infection was observed in 3.3% of patients in the non-retrieval bag group, whereas no infections were reported in the retrieval bag group. Severe postoperative pain (VAS>/= 7) was reported in 10% of the retrieval bag group and 13% of the non-retrieval bag group. However, patients in the retrieval bag group required significantly higher doses of analgesics and experienced delayed return to normal activities. The use of retrieval bags was associated with reduced surgical site infection but increased postoperative pain and delayed recovery. Routine use of retrieval bag may not be necessary in all cases, and their use should be individualized based on intraoperative findings.

KeyWords:

Laparoscopic cholecystectomy, retrieval bag, surgical site infection, gallbladder extraction, postoperative pain

References:

  1. Johnston DE, Kaplan MM. Pathogenesis and treatment of gallstones. N Engl J Med. 1993 Feb;328(6):412–21. 
  2. Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep. 2005 May;7(2):132–40. 
  3. Ouyang G, Liu Q, Wu Y, Liu Z, Lu W, Li S, et al. The global, regional, and national burden of gallbladder and biliary tract cancer and its attributable risk factors in 195 countries and territories, 1990 to 2017: A systematic analysis for the Global Burden of Disease Study 2017. Cancer. 2021 Jul;127(13):2238–50. 
  4. Jaisawal R, Mishra C, Panthee MR, Pathak YR, Acharya A. Prevalence of gall stone disease in Nepal: Multi center ultrasonographic study. Post-Graduate Med J NAMS. 2007;7. 
  5. Almahjoub A, Elfaedy O, Mansor S, Rabea AHA, Abdulrahman A, Alhussaen A. Mini-cholecystectomy versus laparoscopic cholecystectomy: a retrospective multicentric study among patients operated in some Eastern Libyan hospitals. Turkish J Surg. 2019;35 3:185–90. 
  6. Reynolds W. The First Laparoscopic Cholecystectomy. JSLS J Soc Laparoendosc Surg. 2001;5:89–94. 
  7. Lomanto D, Salgaonkar HP, Wijerathne S. Laparoscopy. Encycl Gastroenterol. 2020; 
  8. Costamagna G, Cárdenas A. Postoperative Biliary Strictures and Leaks. Clin Gastrointest Endosc. 2019; 
  9. Duca S, Bãlã O, Al-Hajjar N, Lancu C, Puia IC, Munteanu D, et al. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542  consecutive laparoscopic operations. HPB (Oxford) [Internet]. 2003;5(3):152–8. Available from: https://pubmed.ncbi.nlm.nih.gov/18332976 
  10. H.J. Espiner. Endo-bags for gall bladder removal: an overview. Min lnvas Ther & Allied Techno1 1996: 5: 115-120 
  11. Dr Bhagavan B C et al. Is Endobag Effective in Laparoscopic Cholecystectomy – Our Experience. JMSCR Volume 08 Issue 09 September 2020 
  12. Smorgick N. Laparoscopic specimen retrieval bags. J Obstet Gynaecol India [Internet]. 2014 Oct;64(5):370–2. Available from: https://pubmed.ncbi.nlm.nih.gov/25368466 
  13. Begum S, Khan MR, Gill RC. Cost effectiveness of Glove Endobag in Laparoscopic Cholecystectomy: Review of the available literature. J Pak Med Assoc. 2019 Feb;69(Suppl 1)(1):S58–61. 
  14. Afak Yusuf Sherwani, Hakeem Vaqar Ahmed, Rafia Aziz, et al. Use of Retrieval Bag Using Drain Bag vs Direct Extraction of Gall Bladder Specimen After Laparoscopic Cholecystectomy: Our Experience With 600 Patients. New Indian J Surg. 2020;11(2):93–98. 
  15. Majid MH, Meshkat B, Kohar H, El Masry S. Specimen retrieval during elective laparoscopic cholecystectomy: is it safe not to use a retrieval bag? BMC Surg [Internet]. 2016 Sep 19;16(1):64. Available from: https://pubmed.ncbi.nlm.nih.gov/27643488 
  16. Islam S et. al. Surgical glove use for specimen removal in laparoscopy, the cheapest available: a prospective study 
  17. D. C. Shyam et. al. Cheap Retrieval Bag for Laparoscopic Cholecystectomy 
  18. Novacek. G. Gender and Gallstone Disease. Wien Med Wochenschr (2006) 156/19–20:  527–533 
  19. Vergadia A, Diwakar A, Datey A. Comparative study of Port site infection after gall bladder retrieval using indigenously designed endo-bag and without using endo-bag in Laparoscopic Cholecystectomy. Surgical Review Int J Surg Trauma Orthoped. 2020;6(3):159-165. doi:10.17511/ijoso.2020.i03.04 
  20. Bessa S S et.al. Surgical Glove Bag Versus No Glove Bag For Retrieval Of The Gallbladder Following Laparoscopic Cholecystectomy: A Randomized Comparative Study 
  21. Brenner P. et. al. Postoperative Care of Patients Undergoing Same-Day Laparoscopic Cholecystectomy. AORN J 102 (July 2015) 16-29 
  22. Tamhankar A et.al. Postoperative Symptoms, After-Care, and Return to Routine Activity After Laparoscopic Cholecystectomy. Journal of the Society of Laparoendoscopic Surgeons. 2010. 14:484 – 489 
  23. Qassem MG, Albalkiny S, Behairy GM. Endobag extraction versus direct extraction of gall bladder specimen during laparoscopic cholecystectomy: is routine usage of endobag mandatory? A prospective cohort study. Egypt J Surg [Internet]. 2021;40(2).