Postoperative Outcomes of Low Pressure versus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy

Abstract

Objective: To compare outcomes in laparoscopic cholecystectomy performed with either low-pressure pneumoperitoneum (LPP <12 mm Hg) or standard-pressure pneumoperitoneum (SPP >12 mm Hg).

Methodology: This randomized trial was conducted over six months, from September 2020 to March 2021, with data prospectively collected from patients. Patients aged 20-60 years with symptomatic gallstones were divided between Group A or Group B randomly, with 31 patients in each group. Group A underwent surgery with low-pressure pneumoperitoneum (LPP), whereas Group B underwent surgery with standard-pressure pneumoperitoneum (SPP). Postoperative ileus was assessed at six hours, while shoulder tip pain was evaluated at 24 hours post-surgery, and comparisons were made between both groups.

Results: There were 16 males and 15 females in group A and 14 males and 17 females in group B. Mean age in Group A was 40.35±7.27 years and in Group B 42.28±6.95 years. Group A had an average hospital stay of 1.06 ± 0.21 days and Group B had 1.09 ± 0.37 days. 10 patients (32.3%) experienced right shoulder tip pain in the LPP group as compared to 19 patients (61.3%) in the SPP group (p=0.021). Paralytic ileus was noticed in 6 patients (19.4%) in Group A and 16 patients (51.6%) in Group B (p<0.007).

Conclusion: LLP is a possible and safe option that significantly reduces postoperative shoulder tip pain and paralytic ileus, facilitating earlier bowel recovery compared to standard-pressure pneumoperitoneum.