scholarly journals Comparison of low pressure versus standard pressure pneumoperitoneum for elective laparoscopic cholecystectomy in a tertiary care institute of western India

2018 ◽  
Vol 5 (5) ◽  
pp. 1776
Author(s):  
Ajit Gohil
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Gall Stone ◽  
Low Pressure ◽  
Western India ◽  
Average Hospital ◽  
Post Operative Pain ◽  
Surgeon Experience ◽  
Standard Pressure

Background: Laparoscopic cholecystectomy has proven beyond doubt to be the gold standard in the management of symptomatic cholelithiasis and other gall stone diseases. The aim of this study was to compare the use of the low-pressure pneumoperitoneum (defined as 7-9 mm Hg) with the use of standard pressure pneumoperitoneum (defined as 14 mm Hg) in patients undergoing laparoscopic cholecystectomy in a prospective randomized manner.Methods: This randomized prospective study was carried out in the Department of General Surgery in a tertiary care PDU hospital, in Rajkot, India, from July 2014 to October 2016, with a sample size of 50 patients. Patients were randomized into two groups, one group with 25 patients was undergone laproscopic cholcystectomy with standard pressure pneumoperitoneun at 14 mm hg (SPLC) while the other group with 25 patients was undergone laproscopic cholecystectomy with low pressure pneumoperitoneum at 7-9 mm hg (LPLC).Results: Incidence and intensity of post-operative pain were significantly lower in LPLC group compared to SPLC group. The average change in systolic BP and diastolic BP in patients who underwent LPLC and SPLC was not statistically significant. Average hospital stay for LPLC group are 1.92 days and for SPLC group its 2.48 days.Conclusions: Though surgeon experience quite more difficulty in dissection during low pressure pneumoperitoneum and operative time is quite high, it is significantly advantageous in terms of post-operative pain, use of analgesics, less shoulder tip pain and hospital stay. It is feasible and safe. There was no significant change in SBP and DBP in both groups.

scholarly journals Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy: a comparative study

2020 ◽  
Vol 7 (5) ◽  
pp. 1551
Author(s):  
Arnab Mandal ◽  
Arindam Ghosh ◽  
Sabyasachi Bakshi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Low Pressure ◽  
Oral Feeding ◽  
Post Operative Pain ◽  
Conversion Rates ◽  
Duration Of Surgery ◽  
Standard Pressure ◽  
Per Oral ◽  
The Impact

Background: With the establishment of laparoscopic cholecystectomy as gold standard management of cholelithiasis, the current stress is being given on increasing patient safety and reducing the post-operative morbidity associated with this procedure. An emerging trend is to use of low-pressure pneumoperitoneum in an attempt to lower the impact of pneumoperitoneum while providing adequate working space.Methods: In this prospective randomized study 66 participants were allocated into two arms i.e. low-pressure pneumoperitoneum (LPP) and standard pressure pneumoperitoneum (SPP). The necessary data were collected using laboratory investigations, clinical examination and perioperative findings. Data were analyzed using suitable statistical software.Results: Mean duration of surgery, surgical difficulty and field visualization difficulty were insignificantly greaterin LPP group than SPP group. CO2 consumption was significantly less in LPP. Incidence of bile spillage, usage of drain was insignificantly increased in LPP. Post-operative pain was significantly greater in SPP group. Time for per oral tolerance of food and incidence of nausea were significantly greater in SPP group. Standard pressure group needed significantly more tramadol injection than LPP. There were no significant haemodynamic changes in SPP group compared to LPP group. Length of hospital stay was significantly greater in SPP.Conclusions: Laparoscopic cholecystectomy in low pressure pneumoperitoneum is safe and feasible. Intra-operative complications like operative field visualization, operative difficulties, conversion rates, duration of surgery are not affected moreover, low-pressure pneumoperitoneum, decreases consumption of intra-operative CO2, post-operative pain, shoulder tip pain, need of analgesia, nausea and promotes early per oral feeding, thus reduces hospital stay. 

scholarly journals Prospective randomised trial of standard pressure versus low pressure laparoscopic cholecystectomy in a tertiary care hospital from Kolkata: Our experience

2018 ◽  
Vol 9 (4) ◽  
pp. 17-22
Author(s):  
Bikash Chandra Ghosh ◽  
Ambar Gangopadhyay
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Gall Stone ◽  
Low Pressure ◽  
Stone Disease ◽  
Care Hospital ◽  
Significant Difference ◽  
Gall Stone Disease ◽  
Standard Pressure ◽  
Symptomatic Gall Stone

Background: Laparoscopic cholecystectomy (LC), the procedure of choice for symptomatic gall stone disease. An emerging trend is to perform Low pressure pnuemoperitonium laparoscopic surgery as it has additive advantages over standard pressure to avoid complications while providing adequate working space.Aims and Objectives: The current study was designed with an aim to compare the advantage of low pressure pneumoperitoneum vs standard pressure pneumoperitoneum in laparoscopic cholecystectomy.Materials and Methods: The study was conducted in the department of General Surgery in R.G.Kar Medical College from January 2014 to June 2015. A total of 52 patients with symptomatic gall stone disease were recruited, 26 patients in each group randomly. Some intraoperative and post-operative parameters were studied.Results: All the intra-operative (IO) cardio-respiratory parameters (Pulse, Mean Arterial Pressure (MAP), End tidal CO2, spO2) were recorded just before incision, 20 minutes intra-operatively and before reversal of general anesthesia (GA). The IO parameters in our study, were found to be significant only at 20 minutes IO and before reversal of GA. The post-operative (PO) parameters (Pulse, MAP, Respiratory rate, spO2) and pain by VAS score at 6 hours, 12 hours and 24 hours post-operatively were studied. In PO period, we observed significant differences at 2 hours post-operatively in all parameters except MAP. There was significant difference in pain at 6, 12 and 24 hours when compared in both groups. The shoulder tip pain (STP) and 2 hours PO nausea and vomiting were found to be significantly higher in Standard pressure Laparoscopic cholecystectomy (SPLC) compared to Low pressure Laparoscopic cholecystectomy (LPLC). The operative time, duration of hospital stay and return to normal life after surgery though had differences but it was statisticallyinsignificant.Conclusion: Low pressure laparoscopic surgery is safe with least post operative complications when performed by experienced surgeons even in patients of ASA III.Asian Journal of Medical Sciences Vol.9(4) 2018 17-22

scholarly journals Three-port versus four-port laparoscopic cholecystectomy: a comparative study at a tertiary care centre in North India

2018 ◽  
Vol 5 (2) ◽  
pp. 426
Author(s):  
Peeyush Kumar ◽  
Anil K. S. Rana
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Return To Work ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Gall Stone ◽  
North India ◽  
Duration Of Hospital Stay ◽  
Conversion Rates ◽  
Significant Difference ◽  
Duration Of Surgery

Background: Improvement of Laparoscopic Cholecystectomy (LC) technique in terms of reduction in size and number of ports is being tried to improve patient satisfaction and outcome. Present study was conducted to evaluate and compare the safety outcome and advantages of three-port and four-port LC. Methods: This prospective study included 90 patients presenting with symptomatic gall stone disease or gall bladder polyp more than 1cm at base. Patients with jaundice and choledocholithiasis were excluded. Patients were divided into two groups: A and B, who underwent three-port and four-port LC respectively. Outcomes of the two groups were assessed and compared in terms of duration of surgery, intra-operative and post-operative variables including rate and nature of complications, conversion rates, post-operative pain, duration of hospital stay, return to work and cosmetic outcome.Results: Statistically significant difference was found between the two groups in terms of Visual Analogue Score for pain at 6 and 24 hours, analgesic requirement, duration of hospital stay and return to work; all being less in the three- port LC group. Cosmetic outcome as perceived by patients was also better in the three-port group. Results of other variables were comparable in the two groups. Conclusions: Three-port procedure is safe and appears to be more cost effective than four-port LC. If LC is performed by an experienced surgeon, it can be started with three ports, if required, a fourth port can be inserted. 

scholarly journals Comparative Study of Low Pressure versus Standard Pressure Carbon Dioxide Pneumoperitoneum in Reducing Shoulder Tip Pain Post Laparoscopic Cholecystectomy

2022 ◽  
Vol 19 (1) ◽  
pp. 9-12
Author(s):  
Pradip Thapa ◽  
Divas Thapa ◽  
Anup Sharma
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Intraoperative Complications ◽  
Low Pressure ◽  
Satisfaction Score ◽  
Pressure Group ◽  
Conversion To Open Cholecystectomy ◽  
Procedural Time ◽  
Standard Pressure ◽  
The Impact

Introduction: Laparoscopic cholecystectomy is the gold standard treatment for cholelithiasis. Postoperative shoulder tip pain is common complaint. Evidences suggest that using low pressure pneumoperitoneum (8-10 mmHg) during the procedure rather than standard pressure (12-14 mmHg) decreases the incidence and severity of shoulder tip pain without compromising working space. Aims: The aim of this study was to evaluate the impact of low pressure and standard pressure pneumoperitoneum on shoulder tip pain post laparoscopic cholecystectomy. Methods: A prospective hospital based study conducted at Nepalgunj Medical College, Kohalpur from January 2019 to December 2020. Hundred patients were enrolled, fifty each in “low pressure carbondioxide pneumoperitoneum” and “standard pressure carbondioxide pneumoperitoneum” groups, who underwent laparoscopic cholecystectomy. The two groups were compared in terms of incidence and severity of shoulder tip pain, surgeon’s satisfaction score, top-up analgesia requirement, procedural time, conversion to standard pressure, intraoperative complications and length of hospital stay. Results: There were 45 (90%) females and five (10%) males in low pressure group and 44 (88%) females and six (12%) males in standard pressure group. Fourteen (28%) patients in low pressure and 32 (64%) patients in standard pressure group had shoulder tip pain (p=0.001). The severity of shoulder tip pain was less in low pressure group and was significant at eight hours (p=0.006) and 12 hours (p=0.008). Top-up analgesia was required more in standard pressure group. There were no intraoperative complications but only one conversion to standard pressure. Surgeon’s satisfaction score, conversion to open cholecystectomy and procedural time were comparable in both groups with shorter hospital stay in low pressure group. Conclusion: Low pressure carbondioxide pneumoperitoneum is safe and effective strategy in reducing incidence and severity of shoulder tip pain after laparoscopic cholecystectomy.

scholarly journals Correlation of shoulder tip pain in case of low pressure and standard pressure pneumoperitoneum post laparoscopic cholecystectomy

2021 ◽  
Vol 8 (5) ◽  
pp. 1522
Author(s):  
Lakshman Agarwal ◽  
Sanjay Kumawat ◽  
Sumita A. Jain ◽  
Amit Yadav ◽  
Sandeep Sharma
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Randomized Study ◽  
Visual Analogue Score ◽  
Low Pressure ◽  
P Value ◽  
Pressure Group ◽  
Group A ◽  
Standard Pressure ◽  
Group B

Background: Laparoscopic cholecystectomy is gold standard treatment for cholelithiasis now a days. Post-operative shoulder tip pain is common complain after laparoscopic cholecystectomy. The cause of this shoulder tip pain is multifactorial e.g. peritoneal stretching and diaphragmatic irritation. The main cause of this shoulder tip pain is pneumoperitoneum caused by carbon dioxide. Correlation of shoulder tip pain in case of low pressure (7-8 mmHg) and standard pressure (12-14 mmHg) pneumoperitoneum post laparoscopic cholecystectomy.Methods: A prospective randomized study was done in 100 patients of cholelithiasis in SMS hospital Jaipur Rajasthan. The patients were divided into two groups-Group A patients undergoing laparoscopic cholecystectomy at low pressure (7-8 mmHg) and group B patients undergoing laparoscopic cholecystectomy at standard pressure (12-14 mmHg). The intensity of shoulder tip pain were measured by visual analogue score at 1, 6, 12, 24 and 48 hours. In both of the group results were compared in terms of frequency of pain, intensity of pain and requirement of post-operative analgesics. The duration of hospital stay was also compared.Results: Post-operative shoulder tip was found to be less in low pressure group (group A) as compare to standard pressure group (group B). Total requirement of post-operative analgesic dose and hospital stay was also found to be less in low pressure group as compared to standard pressure group. This was statistically significant (p value<0.05).Conclusions: There is less intensity, frequency of shoulder tip pain, less post-operative analgesics requirement and less post-operative hospital stay after laparoscopic cholecystectomy done under low pressure pneumoperitoneum (7-8 mmHg).

Laparoscopic Surgical Management of Rectal Cancer at Tertiary Care Hospital

2021 ◽  
Vol 15 (11) ◽  
pp. 3285-3287
Author(s):  
Zubair Yousfani ◽  
Jabeen Atta ◽  
Khenpal Das ◽  
Madhu Bala ◽  
Shagufta Magsi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Case Series ◽  
Operation Time ◽  
Health Sciences ◽  
Care Hospital ◽  
Average Hospital ◽  
Case Series Study

Objective: To evaluate the consequent outcomes in the patients with rectal cancer endured laparoscopic surgical excision at Department of Surgery, Liaquat University of Medical and Health Sciences Jamshoro, Hyderabad and to review their curative resection and recurrence rates, postoperative morbidities and complete survival. Methods: This prospective case series study was done at the Department of General Surgery of Liaquat University of Medical & Health Sciences, Jamshoro, Sindh, Pakistan. All patients of 30-65 years ages with rectal cancer and underwent diagnostic laparoscopy either of gender were included. After removing the tumor, the specimen pinned out on a flat surface and placed in fixative solution to allow the orientation of the specimen and assessments of the exact margins. As the specimens had acceptable clear margins and limited invasion to the submucosa, no further surgical procedure was proceeded. Data was collected via study proforma. Results: A total of 40 patients were studied. Patients in the laparoscopic operation lost less blood with an amount of only 200mL during 190 minutes average operation time. The bowel functioning returned in 2 days averagely with 8 days average hospital stay. Conclusion: It is concluded that laparoscopic surgery for rectal cancer is an effective, safe and feasible approach in terms of less post-operative complications and recovery time as well as Hospital stay. Key words: Rectal Cancer, laparoscopic surgery

Impact of standard-pressure and low-pressure pneumoperitoneum on shoulder pain following laparoscopic cholecystectomy: a randomised controlled trial

2016 ◽  
Vol 31 (3) ◽  
pp. 1287-1295 ◽  
Author(s):  
Hemanga K. Bhattacharjee ◽  
Azarudeen Jalaludeen ◽  
Virinder Bansal ◽  
Asuri Krishna ◽  
Subodh Kumar ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Randomised Controlled Trial ◽  
Shoulder Pain ◽  
Controlled Trial ◽  
Low Pressure ◽  
Standard Pressure ◽  
Randomised Controlled
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