Publication:

An observational study on the effect of high versus low carbon dioxide pressure in laparoscopic cholecystectomy

Background Gall bladder stone is one of the common diseases of hepatobiliary system. If it is symptomatic then it needs to be treated and sometimes it may lead to multiple complications. Laparoscopic approach for cholecystectomy is widely acceptable and routinely done procedure for gall bladder stone. Laparoscopic cholecystectomy reduces postoperative pain and hospital stay as compared to open surgery. Laparoscopic surgeries require carbon dioxide (CO2) to inflate peritoneal cavity.

Methods It is an observational study at tertiary care centre. In present study authors have included all patients undergoing elective laparoscopic cholecystectomy. Patients required conversion to open cholecystectomy from laparoscopic cholecystectomy and emergency laparoscopic cholecystectomy and laparoscopic cholecystectomy for malignancy were not included. In present study, patients were randomly allocated into two groups: group A (n=50) low CO2 pressure (8-10 mmHg) pneumoperitonium and group B (n=50) high CO2 pressure (12-14 mmHg) pneumoperitonium to perform laparoscopic cholecystectomy. In present study authors have compared post operative effects in term of pain (at 4, 8 and 12 hrs post operatively), hospital stay and requirements of injectable analgesics between group A and group B.

Results 14 patients in group B complained of post operative shoulder tip pain as compared to only 5 patients in group A. Analgesic requirement and mean length of post operative hospital stay were also less in group A as compared to group B.

Conclusions Low pressure laparoscopic cholecystectomy (LPLC) significantly decrease the frequency and intensity of post operative shoulder tip pain. So, LPLC decrease the demand for postoperative analgesics and decrease post operative hospital stay.