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Port site excision after a keyhole gallbladder removal | CION Cancer Clinics
Port site excision means cutting out the small keyhole scars from an earlier gallbladder removal, because cancer cells can sometimes settle along those tracks. It is no longer done for everyone. Studies have not shown that routine removal changes the outlook, so many surgeons now decide scar by scar. This page explains what they weigh, how it is done, and what it cannot tell you. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is port site excision, and why is it talked about?
- What makes a surgeon more likely to remove a scar?
- How is a port scar removed during the second operation?
- What do families often get wrong about the scars?
- Which words about the scars will you see on the report?
- What changes if a scar is removed or left alone?
- Who does scar removal not suit, and what can this page not tell you?
- Common questions about port site excision
The short answer
What is port site excision, and why is it talked about?
Port site excision means cutting out the small keyhole scars left by an earlier gallbladder removal, along with the full thickness of the belly wall under each one. It is discussed when cancer was found in a gallbladder that had been taken out by keyhole surgery, because cancer cells can sometimes settle in those scars.
Why the scars matter at all
In keyhole surgery the gallbladder is pulled out through one of the small cuts, usually at the belly button. If the gallbladder tore or bile spilled, cells can be left behind along that track. Nobody knew it held cancer at the time.
Why it is no longer automatic
Surgeons once removed every port scar as routine. Larger studies have not shown that doing this for everyone changes the long-term outlook, because cancer in a scar usually goes along with cancer elsewhere in the belly. Many teams now decide scar by scar.
This page explains the reasoning. It cannot tell you whether your own scars will be removed. Only your surgical team can.Before the decision
What makes a surgeon more likely to remove a scar?
No single fact settles it. The team reads these together, alongside your scans and your general health.
What happened in the first operation
A note that the gallbladder tore, that stones or bile spilled, or that no retrieval bag was used makes the scar it came out through more of a concern.
Ask the first hospital for
- The full operation notes
- The discharge summary
- The pathology slides and blocks
What the scar looks and feels like
A new lump, a hard patch or a scar that has thickened since it healed is examined carefully. If a scan also shows something there, removing that scar becomes a much stronger case.
How deep the cancer had grown
Your pathology report says how far into the gallbladder wall the cancer reached. Cancer that grew deeper is more likely to have shed cells, so the team pays closer attention to the scars.
What the camera finds first
Many second operations begin with a quick look inside through a small camera. If there are cancer deposits on the lining of the belly, the plan usually changes, and removing scars stops being the question.
This first look is called a staging laparoscopy.Not sure whether this applies to you?
Ask an oncologistIn theatre
How is a port scar removed during the second operation?
A look for spread
The surgeon usually checks the lining of the belly and the surface of the liver first. Anything suspicious may be sent for a quick check under the microscope while you are still asleep.
The main operation
The radical part comes next: a rim of liver where the gallbladder sat, and the lymph nodes around the main blood vessels and bile duct. Scar removal is added to this, not done instead of it.
Cutting out the scar
An oval of skin is cut around the old scar. The fat, the muscle and the thin inner lining underneath are removed in one piece, so the whole track the instrument once passed through is taken out.
Closing the wall
The layers of the belly wall are stitched back together. Where the gap is larger, the surgeon may use a stronger closure, and a mesh is sometimes discussed. Each piece goes to the laboratory labelled with where it came from.
Commonly believed
What do families often get wrong about the scars?
"The first surgeon must have made a mistake."
Most gallbladder cancers found this way were invisible before and during the first operation. The gallbladder looked like one full of stones. Blaming the first team does not change the plan, and their notes are one of the most useful things you can bring.
"If they remove the scars, the cancer cannot come back there."
Removing a scar takes away one possible place for cells to grow. It does not change what may already be elsewhere in the belly. That is why the pathology report and follow-up scans still matter after the scars are gone.
"If they leave the scars, they are cutting corners."
Leaving a clean-looking scar alone is a considered choice many teams make. Removing it adds a bigger wound, more pain and a higher chance of a hernia later. A surgeon who explains why a scar is being left is doing the job properly.
"A lump in the scar is always cancer."
Scars can form hard knots of healing tissue, and small hernias are common at the belly button. A lump needs checking, often with a scan or a needle sample, but it should not be assumed to be cancer before that.
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On your report
Which words about the scars will you see on the report?
- Port or port site
- The small cut through which a keyhole instrument or camera was passed. Most gallbladder operations leave three or four.
- Extraction site
- The port through which the gallbladder was pulled out. It is usually the one that gets the most attention.
- Full-thickness excision
- Removal of every layer of the belly wall at the scar, from the skin down to the inner lining.
- Port site recurrence
- Cancer growing in an old keyhole scar. It usually means the cancer has spread inside the belly as well.
- Incidental gallbladder cancer
- Cancer that was only found when the removed gallbladder was examined in the laboratory, not before the operation.
- Negative for malignancy
- No cancer cells were found in that piece of tissue.
Side by side
What changes if a scar is removed or left alone?
Scar removed
Scar left alone
The laboratory can check the scar tissue for cancer cells
The scar is watched on examination and follow-up scans
A larger wound, with more soreness in the first weeks
No extra wound beyond the main operation
A higher chance of a hernia or wound infection at that spot
No added hernia risk from the scar itself
More often chosen when a scar looks abnormal or bile spilled
More often chosen when the scar is clean and scans are clear
Being straight with you
Who does scar removal not suit, and what can this page not tell you?
Scar removal is not useful for someone whose cancer has already spread across the lining of the belly or into the liver in several places. In that case a bigger operation adds pain and recovery time without changing the direction of the illness, and treatment usually moves to medicines instead.
It may not suit a frail body
For someone with a weak heart, poor lungs or a large, weak belly wall, extra wounds carry extra risk. The team may decide the main operation is enough of a load. That is a judgement about the whole person, not a sign that anyone has given up.
What only your team can answer
This page cannot tell you whether cancer is in your scars, whether they will be removed, or what your outlook is. Useful questions to ask: which scar did the gallbladder come out through, was bile spilled, and what would make you remove a scar or leave it?
Bring the first operation notes and the pathology blocks. A second opinion is much faster when the slides can be looked at again.Questions we are asked
Common questions about port site excision
Will all my keyhole scars be cut out?
Not necessarily. Many teams no longer remove every scar as routine. They look at the first operation notes, how deep the cancer grew, what the scars look like and what the camera shows inside. Some people have one scar removed, some have all of them removed, and some have none. Ask your surgeon which plan fits your case and why.
Does removing the scars make the operation much longer?
It adds some time, but most of the operation goes on the liver rim and the lymph nodes. The bigger difference is felt afterwards, as extra soreness at each place where a scar was removed. Your anaesthetist will plan pain relief with that in mind.
Will I have a bigger scar afterwards?
Usually yes. Each removed scar is replaced by a longer oval-shaped cut, and the second operation often needs its own cut as well. The final look depends on how many scars are removed and whether the main operation is done open or by keyhole. Your surgeon can show you roughly where the new cuts will sit.
What if cancer is found in the removed scar?
It usually tells the team that cancer cells had spread inside the belly, not only into the scar. That can change the plan after surgery, often towards chemotherapy, and it changes how closely you are followed. Your oncologist will explain what it means for you. The finding on its own does not tell anyone how things will go.
Can the scars be removed without a second big operation?
Scar removal is almost always part of the second, radical operation. On its own it would not deal with the liver bed or the lymph nodes, where the team is most concerned about leftover cancer. If no second operation is planned, removing scars alone is rarely suggested.
Am I more likely to get a hernia?
Yes, somewhat. Removing the whole thickness of the belly wall leaves a weaker spot, especially at the belly button. Avoid heavy lifting for as long as your surgeon advises, and support the wound when you cough. A soft bulge that grows when you strain should be shown to your team, even months later.
My first surgery was in another town. Does that matter?
Not for the decision itself, but the paperwork matters. Ask that hospital for the operation notes, discharge summary and pathology blocks as early as you can. Having them at the first appointment makes the plan faster and more accurate.
What should I watch for at the scar sites after I go home?
Increasing redness, warmth, pus, a wound that opens, or a fever should be reported to your team the same day. Later on, a new lump or bulge at an old scar is worth mentioning at follow-up rather than waiting for the next scan. Mild soreness and a firm ridge under a healing scar are common.
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Sources
- Cancer Research UK — Surgery for gallbladder cancer
- American Cancer Society — Surgery for Gallbladder Cancer
- National Cancer Institute — Gallbladder Cancer Treatment (PDQ), patient version
- Macmillan Cancer Support — Gallbladder cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Cancer Found After a Routine Gallbladder RemovalWhere most port site questions beginWhy a Second Operation Is Needed After Incidental CancerThe operation scar removal is part ofLiver Bed Resection With the GallbladderThe main part of the second operationWound, Stitches and ScarsLooking after the new wounds at homeThe Pathology Report After SurgeryReading what the laboratory found in the scars
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Cancer found after your gallbladder was removed?
Send us the pathology report and the first operation notes. A surgical oncologist will explain what the second operation may involve, including the scars. One helpline serves every CION centre.