Laparoscopic Cholecystectomy: Low Pressure Versus Standard Pressure Pneumoperitoneum

Vijay Kumar, Zahid Mehmood, Fizza Khalid, Manzoor Ahmed, Saad Abdul Razzak

Abstract

Objective

To compare the postoperative outcome of low pressure pneumoperitoneum versus standard pressure pneumoperitoneum among patients undergoing laparoscopic cholecystectomy (LC).

Study design

Comparative study.

Place & Duration of study

Department of General Surgery ward 25, Jinnah Postgraduate Medical Center (JPMC) Karachi, from June 2019 to November 2020.

Methodology

A total of 168 patients who underwent laparoscopic cholecystectomy were included in this study after ethical committee approval. Patients were divided into 2 equal groups of 84 each by lottery method. Group 1 patients underwent laparoscopic cholecystectomy using standard pressure pneumoperitoneum (12-18 mmHg) while group 2 patients underwent laparoscopic cholecystectomy using low pressure pneumoperitoneum (8-12 mmHg). The operative time was compared between the two groups and postoperatively all the patients were observed for shoulder tip pain and vomiting. Frequency and intensity of postoperative shoulder tip pain was assessed at 4,8,12 and 24 hours using visual analogue score.

Results

Twenty-two (26.19%) patients complaint of shoulder pain who underwent LC at standard pressure while it was 8.33% in low pressure group that was statistically significant (p=0.005). The mean postoperative pain score as per visual analogue score was 1.42±1.68 in group 1 it was 0.92 ± 1.07 in group 2. The difference between the two groups was again statistically significant (p=0.023). The frequency of vomiting was 11.90% in Group 1 and 8.33% in Group 2. The difference being statistically insignificant (p=0.443).

Conclusions

Low pressure pneumoperitoneum was better than standard pressure pneumoperitoneum in patients undergoing laparoscopic cholecystectomy in terms of frequency and intensity of shoulder tip pain. However, there was no difference between the two groups in terms of frequency of postoperative vomiting.

Key words

Laparoscopic cholecystectomy, Standard pressure pneumoperitoneum, Low pressure pneumoperitoneum, Gallstone.