Low-pressure vs Standard-pressure in Laparoscopic Cholecystectomy

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

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Prospective randomized trial of low pressure versus standard pressure pneumo-peritoneum in laparoscopic cholecystectomy

Sri Lanka Journal of Surgery ◽

10.4038/sljs.v32i1.6867 ◽

2014 ◽

Vol 32 (1) ◽

pp. 19

Author(s):

P. Shivhare ◽

P Dugg ◽

S. Mittal ◽

H. Singh ◽

A. Kumar ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Randomized Trial ◽

Low Pressure ◽

Prospective Randomized Trial ◽

Standard Pressure

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Comparison of standard and low-pressure pneumoperitoneum; reduction in frequency and intensity of post-operative shoulder pain

Journal of Shifa Tameer-e-Millat University ◽

10.32593/jstmu/vol2.iss2.47 ◽

2019 ◽

Vol 2 (2) ◽

pp. 47-51

Author(s):

Sania Waseem ◽

Humera Naz Altaf ◽

Sehrish Latif ◽

Omar Shahzad Altaf ◽

Fareeha Farooqui ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Abdominal Cavity ◽

Low Pressure ◽

Intraabdominal Pressure ◽

P Value ◽

Reduced Pressure ◽

Quasi Experimental ◽

Group A ◽

Standard Pressure ◽

Group B

Laparoscopic cholecystectomy is now gold standard and depends on good exposure of the peritoneal cavity. It is achieved by insufflation of the abdominal cavity with CO2. Operating at lower intraabdominal pressure (<12 -15mmHg) has been associated with fewer pulmonary and hemodynamic complications and lesser postoperative pain. Objective: To ascertain the advantages of low pressure pneumoperitoneum over standard pressure pneumoperitoneum Methods: Our study was quasi experimental study conducted at KRL Hospital, Islamabad over period of 3years from 2013 to 2016. SPSS version 20 was used to calculate p value. Results: A total of 456 patients of gallstones were equally divided in two groups assigned to undergo low pressure (7-8mm of Hg) pneumoperitoneum or standard pressure (12-14mm of Hg) pneumoperitoneum laparoscopic cholecystectomy The average age of patients was 46.2+/-13.6yrs in group A compared to 43.5 +/- 12.9 in group B. There were 60 (26.3%) male and 168 (73.7%) female patients in group A compared to 53 (23.2% and 175 (76.85) in group B respectively. It was found that group A 14 (6.1%) had no pain, 26 (11.4%) had VAS between 1 – 7 and 188 (82.5%) had VAS of 8 – 10 where as in group B 164 (72.6%) patients reported no shoulder tip pain postoperatively, 42 (18.6%) had VAS of 1 – 7 and 20 (8.8%) had VAS OF 8 – 10. The difference was statistically significant (p-value = <0.001). Conclusions: reduced pressure of pneumoperitoneum to 7 – 8 mm of Hg produce lower incidence of postoperative shoulder tip pain.

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EVALUATION OF POSTOPERATIVE SHOULDER TIP PAIN IN LOW PRESSURE VERSUS STANDARD PRESSURE PNEUMOPERITONEUM DURING LAPAROSCOPIC CHOLECYSTECTOMY

10.36106/gjra/2305569 ◽

2021 ◽

pp. 28-29

Author(s):

Om Prakash Pawar ◽

Ranjana Sinha

Keyword(s):

Carbon Dioxide ◽

Laparoscopic Cholecystectomy ◽

Low Pressure ◽

Postoperative Rehabilitation ◽

Diaphragmatic Muscle ◽

Group A ◽

Standard Pressure ◽

The Mean ◽

Group B ◽

Postoperative Shoulder

Introduction:- Insufation of carbon dioxide during laparoscopic cholecystectomy carries on to postoperative shoulder tip pain. The beginning of shoulder pain is commonly presumed to be due to overstretching of the diaphragmatic muscle bres due to high carbon dioxide pressure. Methods: - Patients came and admitted to the surgery department for elective cholecystectomy were enrolled in the study. The patients were randomly divided in two groups (group A and group B). In group A - low-pressure pneumoperitoneum (8 mm Hg) and in group B- standard pressure pneumoperitoneum (14 mm Hg) was created during laparoscopic cholecystectomy. Postoperative shoulder tip pain was evaluated at 4 hours and 24 hours after the operation. Results:- Fourteen patients or 28 % of patients in group B complained of postoperative shoulder tip pain as collated to only ve patients (10%) in group A. The mean intensity of postoperative shoulder tip pain assessed by the visual analogue scoring scale at 4 hours and 24 hours was less in group A as collated to group B. However, statistical signicance was seen only at four hours. Analgesic requirements and the mean length of postoperative stay in the hospital were minor in group-A as collated to group B. Conclusion: - Low-pressure laparoscopic cholecystectomy signicantly reduces the frequency and intensity of postoperative shoulder tip pain. Low-pressure laparoscopic cholecystectomy decreases the demand for postoperative analgesics, decreases postoperative hospital stay, and improves the quality of life in the initial stage of postoperative rehabilitation.

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