A prospective randomized trial on comparison of low-pressure (LP) and standard-pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy

Abstract

LP pneumoperitoneum is superior to SP pneumoperitoneum in terms of lower postoperative pain, a lower incidence of shoulder-tip pain, and a better QOL within 5 days following the operation. LP should be used for LC in cases of uncomplicated symptomatic gallstones as a recommended procedure as long as an adequate exposure is obtained with this technique.

Shoulder Tip Pain Following Laparoscopic Cholecystectomy—a Randomized Control Study to Determine the Cause

“…Some studies have also shown that the shoulder tip pain is minimal if the initial insufflation rate is kept suboptimal, although this needs to be substantiated. Some studies have shown that the incidence and intensity of postoperative shoulder tip pain was significantly less in the low-pressure pneumoperitoneum group when compared with standard-pressure pneumoperitoneum groups [8,[11][12][13][14][15][16]. Our study, however, shows that the incidence of shoulder pain has no statistical difference between groups undergoing laparoscopic surgery at different pneumoperitoneal pressures.…”

Feasibility and Safety of Low Pressure Pneumoperitoneum for Laparoscopic Cholecystectomy: A Prospective, Randomized, Triple-Blinded Trial

“…As mentioned, this problem was partly circumvented by initially piercing the anterior abdominal fascia with a blade, and by sometimes using slightly oblique tracts. Anticipating this, others in similar situations have used a higher pressure initially for port placement [7,9,12,16]. We feel that the higher initial pressure might confound the cardiopulmonary variables in the LPLC group.…”

“…Diaphragmatic irritation due to surgical drains or bile is also believed to play role, especially with regard to shoulder-tip pain. [9] Higher pressures of PP are believed to predispose to worse pain scores after LC. After adequate blinding of patients to eliminate bias, two studies report significant decrease in overall pain with low pressure PP.…”

“…After adequate blinding of patients to eliminate bias, two studies report significant decrease in overall pain with low pressure PP. [8,9] Gurusamy et al, in their systematic review, believe the main advantage of low pressure PP is, in fact, decreased pain. [11] This is probably the only positive result in our study too.…”

“…Several studies have compared the effects of reduced pressure (7-9 mm Hg) with standard pressure (12-15 mm Hg) during LC [7][8][9][10][11]. These studies illustrate the feasibility of low pressure PP, along with some advantages in terms of postoperative pain.…”