Intraoperative safety of low pressure pneumoperitoneum cholecystectomy: a comparative study

Abstract

Background: With the establishment of laparoscopic cholecystectomy as gold standard for management of cholelithiasis, the current stress is on increasing patient safety. Hence, this study was undertaken to compare the effect of low pressure pneumoperitoneum (LPP <10mm Hg) versus high pressure pneumoperitoneum (HPP >14mm Hg) in a prospective randomized manner on intraoperative safety, assessing the working space and safety by seeing contact of parietal peritoneum to underlying viscera during secondary port insertion.Methods: 120 patients undergoing laparoscopic cholecystectomy were randomized into the LPP (<10mm Hg) group (n=60) and the HPP (>14mm Hg) group (n=60) prospectively. Available working space assessed directly, safety by contact of parietal peritoneum to underlying viscera during secondary port insertion and operative difficulty assessed by visualization, dissection and grasping, total duration of surgery; intra-operative gas consumption, and bile spillage were assessed.Results: There was no significant difference in terms of available working space, operative duration, consumption of carbon dioxide, surgeon’s operative difficulty and intraoperative bile spillage. Out of 180 secondary ports inserted, there was evident contact of 20 (11.1%) secondary ports in high pressure groups and 14 (7.7%) secondary ports in low pressure group, which is suggestive of adequate exposure and working space available for surgery at both pressures.Conclusions: Low-pressure cholecystectomy did not compromise intraoperative safety and should be the standard of care in day care surgery.

Effect of Low-pressure Pneumoperitoneum on Pain and Inflammation in Laparoscopic Cholecystectomy: A Randomized Controlled Clinical Trial

“…Mahajan et.al suggested to standardize low-pressure laparoscopic cholecystectomy in day care surgery, as they found the procedure to be safe and feasible, with no signi cant difference when compared to standard pressure pneumoperitoneum in terms of adequacy of surgical eld, contact of parietal peritoneum to the underlying viscera during secondary port insertion, duration of surgery, complication rates, and surgery di culty. 13 In this trial the total operative time, insu ation time and total hospital stay was similar across both groups. None of the patients had major intraoperative complication, 30-day mortality rate was zero in both groups, only 3 patients in the low-pressure group had a change from initial set pressure point, and 4…”

Effect of low-pressure pneumoperitoneum on pain and inflammation in laparoscopic cholecystectomy: a randomized controlled clinical trial

“…Our trial supports similar results even in the hands of non-experienced surgeons. Mahajan et al suggested to standardize low-pressure laparoscopic cholecystectomy in day care surgery, as they found the procedure to be safe and feasible, with no significant difference when compared to standard pressure pneumoperitoneum in terms of adequacy of surgical field, contact of parietal peritoneum to the underlying viscera during secondary port insertion, duration of surgery, complication rates, and surgery difficulty [ 13 ].…”

Postoperative outcome and hemodynamic changes in high versus low pressure to pneumoperitoneum in patients undergoing laparoscopic cholecystectomy

“…The standard pressure in pneumoperitoneum is 12-14 mmHg; it is also associated with complications that usually happen following the prolonged and difficult surgeries due to head-down position and pneumoperitoneum; for example, reduced lung capacity, hemodynamic complications, changes in the concentration of arterial blood gases, increased liver enzymes, renal failure, post-operative abdominal and shoulder-tip pain. [4][5][6] Recently, to reduce the complications, surgeons tend to use gases with 7-10 mmHg pressure instead of the standard high pressure. Using lower pressure obtains good results such as less post-op abdominal and shoulder tip pain, less pulmonary complications.…”