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).

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.

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 Effects of low versus standard pressure pneumoperitoneum on renal syndecan-1 shedding and VEGF receptor-2 expression in living-donor nephrectomy: a randomized controlled study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dita Aditianingsih ◽  
Chaidir Arif Mochtar ◽  
Aida Lydia ◽  
Nuryati Chairani Siregar ◽  
Nur Ita Margyaningsih ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Low Pressure ◽  
Donor Nephrectomy ◽  
Intraabdominal Pressure ◽  
Vascular Endothelial ◽  
Pressure Group ◽  
Peritubular Capillary ◽  
Living Donor Nephrectomy ◽  
Standard Pressure ◽  
Renal Tubular

Abstract Background Laparoscopic nephrectomy is a preferred technique for living kidney donation. However, positive-pressure pneumoperitoneum may have an unfavorable effect on the remaining kidney and other distant organs due to inflamed vascular endothelium and renal tubular cell injury in response to increased systemic inflammation. Early detection of vascular endothelial and renal tubular response is needed to prevent further kidney injury due to increased intraabdominal pressure induced by pneumoperitoneum. Transperitoneal laparoscopic living donor nephrectomy represented a human model of mild increasing intraabdominal pressure. This study aimed to assess the effect of increased intraabdominal pressure on vascular endothelium and renal tubular cells by comparing the effects of low and standard pressure pneumoperitoneum on vascular endothelial growth factor receptor-2 (VEGFR-2) expression and the shedding of syndecan-1 as the early markers to a systemic inflammation. Methods We conducted a prospective randomized study on 44 patients undergoing laparoscopic donor nephrectomy. Subjects were assigned to standard (12 mmHg) or low pressure (8 mmHg) groups. Baseline, intraoperative, and postoperative plasma interleukin-6, syndecan-1, and sVEGFR-2 were quantified by ELISA. Syndecan-1 and VEGFR-2 expression were assessed immunohistochemically in renal cortex tissue. Renal tubule and peritubular capillary ultrastructures were examined using electron microscopy. Perioperative hemodynamic changes, end-tidal CO2, serum creatinine, blood urea nitrogen, and urinary KIM-1 were recorded. Results The low pressure group showed lower intra- and postoperative heart rate, intraoperative plasma IL-6, sVEGFR-2 levels and plasma syndecan-1 than standard pressure group. Proximal tubule syndecan-1 expression was higher in the low pressure group. Proximal-distal tubules and peritubular capillary endothelium VEGFR-2 expression were lower in low pressure group. The low pressure group showed renal tubule and peritubular capillary ultrastructure with intact cell membranes, clear cell boundaries, and intact brush borders, while standard pressure group showed swollen nuclei, tenuous cell membrane, distant boundaries, vacuolizations, and detached brush borders. Conclusion The low pressure pneumoperitoneum attenuated the inflammatory response and resulted in reduction of syndecan-1 shedding and VEGFR-2 expression as the renal tubular and vascular endothelial proinflammatory markers to injury due to a systemic inflammation in laparoscopic nephrectomy. Trial registration ClinicalTrials.gov NCT:03219398, prospectively registered on July 17th, 2017.

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

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 Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Prospective, Randomized Study

2014 ◽  
Vol 99 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Alper Bilal Özkardeş ◽  
Mehmet Tokaç ◽  
Ersin Gürkan Dumlu ◽  
Birkan Bozkurt ◽  
Ahmet Burak Çiftçi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Operation Time ◽  
Early Laparoscopic Cholecystectomy ◽  
Laparoscopic Cholecystectomy Group ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy

Abstract We aimed to compare the clinical outcome and cost of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Sixty patients with acute cholecystitis were randomized into early (within 24 hours of admission) or delayed (after 6–8 weeks of conservative treatment) laparoscopic cholecystectomy groups. There was no significant difference between study groups in terms of operation time and rates for conversion to open cholecystectomy. On the other hand, total hospital stay was longer (5.2 ± 1.40 versus 7.8 ± 1.65 days; P = 0.04) and total costs were higher (2500.97 ± 755.265 versus 3713.47 ± 517.331 Turkish Lira; P = 0.03) in the delayed laparoscopic cholecystectomy group. Intraoperative and postoperative complications were recorded in 8 patients in the early laparoscopic cholecystectomy group, whereas no complications occurred in the delayed laparoscopic cholecystectomy group (P = 0.002). Despite intraoperative and postoperative complications being associated more with early laparoscopic cholecystectomy compared with delayed intervention, early laparoscopic cholecystectomy should be preferred for treatment of acute cholecystitis because of its advantages of shorter hospital stay and lower cost.

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