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 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 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.

A FOLLOW-UP STUDY - LOW-PRESSURE PNEUMOPERITONEUM COMPARED TO STANDARD PNEUMOPERITONEUM IN LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
pp. 26-27
Author(s):  
Om Prakash Pawar ◽  
Ranjana Sinha
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operative Time ◽  
Pain Syndrome ◽  
Low Pressure ◽  
Test Methods ◽  
Clinical Test ◽  
Pressure Group ◽  
Duration Of Surgery ◽  
Standard Pressure ◽  
Elective Laparoscopic Cholecystectomy

Introduction-: Post-laparoscopic pain syndrome is well conceded and characterized by abdominal and especially shoulder tip pain. It occurs frequently following laparoscopic cholecystectomy. The etiology of post-laparoscopic pain can be classied into three aspects visceral, incision, and shoulder. This study purposed to compare the frequency and strength of shoulder tip pain between low pressure (7 mmHg) and standard pressure (14 mmHg) in a prospective randomized clinical test. Methods-: One hundred forty successive patients undergoing elective laparoscopic cholecystectomy were randomized prospectively to either low or high-pressure pneumoperitoneum. The statistical analysis included mean age, weight, sex, duration of surgery, conversion rate, American Society of Anesthesiologists (ASA) grade, operative time, incidence and severity of shoulder tip pain, and post-operative hospital stay. Results -: The patient's quality was similar in the two groups except for the predominance of males in the standard-pressure group. The plan of action was successful in 68 of 70 patients in the low-pressure group. The number of analgesic injections, visual analog score, operative time, and length of post-operative days were the same in all groups. Occurence of shoulder tip pain was higher in the standard-pressure group, but not statistically signicantly so (p = 0.100) (27.9% versus 44.3%). Conclusions -: Low-pressure pneumoperitoneum tended to be better than standard-pressure pneumoperitoneum in a period of lower incidence of shoulder tip pain. Still, this difference did not reach statistical signicance following elective laparoscopic cholecystectomy

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 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).

Efficacy of Thiol disulfide Homeostasis and Ischemia Modified Albumin Values in Estimating the Degree of Difficulty for Laparoscopic Cholecystectomy

2020 ◽  
Vol 23 ◽  
Author(s):  
Gökhan Akkurt ◽  
Burcu Akkurt ◽  
Emel Alptekın ◽  
Birkan Birben ◽  
Mehmet Keşkek ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Demographic Data ◽  
Previous History ◽  
Significant Negative Correlation ◽  
White Blood Count ◽  
Ischemia Modified Albumin ◽  
Total Thiol ◽  
Duration Of Surgery ◽  
History Of

Aim: The aim of this study is to investigate the efficacy of thiol disulfide homeostasis and Ischemia Modified Albumin (IMA) values in predicting the technical difficulties that might be encountered during laparoscopic cholecystectomy. Materials and Methods: The study included 65 patients who underwent laparoscopic cholecystectomy due to cholelithiasis at the General Surgery Clinic of Ankara Numune Training and Research Hospital. All patients’ demographic data, previous history of cholecystitis, a history of chronic illness, preoperative white blood count (WBC), liver function tests (AST, ALT), amylase and lipase levels, intra-operative adhesion score, the ultrasonographic appearance of gallbladder, duration on hospital stay, duration of operation, thiol disulfide and IMA values were evaluated. Results: Native thiol and total thiol averages were higher in patients without a history of cholecystitis, on the other hand, disulfide, disulfide/native thiol rate, disulfide/total thiol rate, native thiol/total thiol rate and IMA averages were higher in patients with a history of cholecystitis. While there was a statistically significant negative correlation between native and total thiol values and age, duration of surgery and duration of hospital stay; IMA, disulfide, disulfide/Total thiol, Native/Total thiol and disulfide/Native thiol rates were higher in older patients with a longer duration of surgery and hospital stay. In addition, preoperative IMA, disulfide, disulfide/Total thiol, Native/Total thiol and disulfide/Native thiol were observed to increase as the degree of intraoperative pericholecystic adhesion increased. Conclusion: We believe that the evaluation of thiol disulfide homeostasis and IMA parameters prior to laparoscopic cholecystectomy can be used as an effective method for predicting intraoperative difficulties.

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

2017 ◽  
Vol 4 (11) ◽  
pp. 3740
Author(s):  
Salil Mahajan ◽  
Manu Shankar ◽  
Vinod K. Garg ◽  
Vijender Gupta ◽  
Jaya Sorout
Keyword(s):  
High Pressure ◽  
Laparoscopic Cholecystectomy ◽  
Shoulder Pain ◽  
Postoperative Period ◽  
Low Pressure ◽  
Randomized Clinical Study ◽  
Early Return ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Bile Spillage

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.

Duration of Surgery, Ventilation, and Length of Hospital Stay Do Not Affect Breastfeeding in Newborns After Early Cleft Lip Repair

2020 ◽  
pp. 105566562094911
Author(s):  
Iva Burianova ◽  
Milos Cerny ◽  
Jiri Borsky ◽  
Kristyna Zilinska ◽  
Jana Dornakova ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Repair ◽  
Artificial Ventilation ◽  
Duration Of Hospital Stay ◽  
Duration Of Surgery ◽  
Ventilation Support ◽  
Cleft Lip Repair ◽  
The Impact

Objective: There are minimal data available on nutrition after early repair of cleft lip and the factors influencing initiation of breastfeeding. This study assessed the impact of the length of surgery, length of ventilation support, and duration of hospital stay on breastfeeding rates after early cleft lip surgery. Design: This is a prospective observational cohort study comparing 2 hospitals providing early surgical repair of facial clefts from January 2014 to December 2016. Both hospitals are designated as Baby-Friendly Hospitals. Demographic and anthropometric data from mothers and newborns were recorded. Setting: Tertiary neonatal and pediatric surgery center. Patients: Hospital A: 61 newborns, Hospital B: 157 newborns. Interventions: Early (day 5 to 14) cheiloplasty in newborns with cleft lip or cleft lip and palate. Main Outcome Measures: Influence of duration of hospital stay, length of operation, and artificial ventilation on the rate of breastfeeding. Results: Significantly, more newborns were breastfed following early surgical repair of an isolated cleft lip compared to those with both cleft lip and palate, in both hospitals (hospital A 82% vs 0%, P = .0001, hospital B 66% vs 5%, P = .0001). Duration of hospital stay, length of operation, and duration of artificial ventilation did not significantly affect the rate of breastfeeding. Conclusions: The factors associated with early cleft lip repair (length of operation, length of ventilation support, and duration of hospital stay) do not affect breastfeeding rate.

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