Outcome analysis of low pressure versus high pressure pneumoperitoneum laparoscopic cholecystectomy: a randomized clinical study

Abstract

Background: Laparoscopic cholecystectomy is established as gold standard for management of cholelithiasis. Intraoperative pneumoperitoneum affects the postoperative outcomes. The current stress is on increasing patient safety. Hence, this prospective study was undertaken to compare the effect of low pressure pneumoperitoneum (LPP <10 mm Hg) versus high pressure pneumoperitoneum (HPP > 14 mm Hg) on postoperative pain and ileus.Methods: 120 patients undergoing laparoscopic cholecystectomy were randomized into the LPP (<10mm Hg) group (n=60) and the HPP (>14 mm Hg) group (n=60). Total duration of surgery, intra-operative gas consumption, occurrence of bile spillage during operation, shoulder pain and abdominal pain in postoperative period, additional requirement of analgesia in postoperative period and postoperative ileus were assessed.Results: There was no significant difference in terms of operative duration, consumption of CO2 gas, intraoperative bile spillage, total hospital stay and tolerance to early feeding. The incidence of shoulder pain was higher in patients who underwent HPP laparoscopic cholecystectomy (p<0.05). There was early recovery and early return of bowel activity in LPP which was statistically significant.Conclusions: Low-pressure pneumoperitoneum is feasible and safe and results in reduced postoperative shoulder tip pain and near-equal operative time with early return of bowel activity compared with high-pressure pneumoperitoneum.

Effects of Low and Standard Intra-Abdominal Pressure on Postoperative Pain in Laparoscopic Cholecystectomy

“…For example, a prospective randomized trial comparing standard pressure versus low-pressure LC was done in a tertiary care hospital in Kolkata, India, in which Ghosh, Gangopadhyay, 14 have accessed post-operative pain by VAS score at 6 hours, 12 hours and 24 hours post-operatively and concluded that there was a significant difference in pain at 6, 12 and 24 hours in low-pressure pneumoperitoneum as compared to high-pressure pneumoperitoneum. Similarly, it was concluded by Mahajan et al, 5 five that low pressure (less than 10 mmHg) pneumoperitoneum is not only a safe approach with similar outcomes when compared to high pressure (more than 14 mmHg), but it is also associated with lesser post-operative pain. Likewise, in the studies mentioned earlier, in our study, more patients who were operated on under high pneumatic pressure (>15 mmHg) had complaints of abdominal pain as compared to the low-pressure group (8-12 mmHg).…”

“…Besides, it may cause post-operative pain due to peri-toneal irritation, and its use is associated with immunological impairment. 5,6 The increased intra-abdominal pressure (IAP) is associated with cardiopulmonary complications such as tachycardia, cardiac arrhythmias, pulmonary oedema, and reduced hepatic and renal blood flow. Decrease hepatic blood flow can cause hepatic injury and raised liver enzymes level, while decreased renal blood flow can lead to kidney injury and oliguria.…”

“…These hemodynamic changes may result in considerable side effects for the patients, especially if they are aged or have other associated comorbidity. 5 In surgical practice, a pressure of 8-12 mmHg is considered low, while a pressure of 15 mmHg or above is considered high pneumatic pressure. 7 Though in LC, post-operative pain is usually less severe than open cholecystectomy during the first 6-12 hours, it is still one of the major problems patients face.…”