Publication:

Postoperative outcome and hemodynamic changes in high versus low pressure to pneumoperitoneum in patients undergoing laparoscopic cholecystectomy

Background A pneumoperitoneum is created by insufflating a gas (usually carbon dioxide) into the peritoneal cavity during laparoscopic surgery. Intra-abdominal pressure (IAP) rises as a result of this. At a rate of 4–6 liter min-1, carbon dioxide is insufflated into the peritoneal cavity at a pressure of 10–20 mm Hg. Aim of the research was to compare the hemodynamic effects and the level of post-operative symptoms due to high pressure and low-pressure pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.

Methods 60 patients fulfilling inclusion criteria who were posted for elective cholecystectomy under general anaesthesia were divided into two groups, 30 patients in each group. Group L included pneumoperitoneum created with intra-abdominal pressure of 7-10 mmHg, and group H included pneumoperitoneum created with intra-abdominal pressure of 12-14 mmHg. Variables such as the systolic blood pressure, diastolic blood pressure, heart rate, end-tidal CO2, the level of post-operative abdominal pain, shoulder-tip pain, nausea and vomiting, and the liver function test were compared between the two groups.

Results Between groups, no statistical difference has been noted in the demographic characters of the patient. There was a statistical difference of intraoperative and post-operative systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) between groups. End-tidal CO2 was compared between the two groups during the surgery and a significant difference regarding EtCO2. Liver function tests showed a significant difference in all measured factors after surgery between the two groups.

Conclusions Low-pressure pneumoperitoneum decreases hemodynamic complications. Post-operative abdominal pain, shoulder tip pain, nausea and vomiting are reduced.