Feasibility and Safety of Low Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy

Abstract

Objective: To observe the feasibility and safety of low pressure pneumoperitoneum in laparoscopic cholecystectomy in terms of changes in liver enzymes, operative time, post- operative pain and postoperative hospital stay.
Material and methods: This comparative Cross Sectional Study was conducted at department of Surgery, LUMHS/Jamshoro from November 2023. Patients with gallstones planned for laparoscopic cholecystectomy were included. Patients were randomly assigned to either the low-pressure or standard-pressure pneumoperitoneum groups. During surgery, patients in the low-pressure group were have pneumoperitoneum established and maintained at <10 mmHg, while those in the standard-pressure group was have it maintained at 14-15 mmHg. The operative time, from the first incision to the closure of the last port site, was recorded. Postoperatively, liver enzyme levels were measured at 6, 24, and 48 hours to monitor changes in liver function. Postoperative pain and duration of the hospital stay were recorded. The safety of low-pressure pneumoperitoneum was evaluated by comparing complication rates between the two groups. Data was analyzed using SPSS software version 26.
Results: Overall patient’s mean age was 40.74 +12.37 years with female predominance
83.9%. Findings showed that patients in the low-pressure group had better outcomes as,
none of them had changes in liver function tests, while 11.3% in the standard-pressure
group did (p = 0.006). The surgery time was shorter in the low-pressure group (33.79
minutes vs. 44.93 minutes, p = 0.001). They also felt less pain (average score 2.72 vs.
4.38, p = 0.001), had less drain output (23.73 ml vs. 46.96 ml, p = 0.001), and stayed in
the hospital for a shorter time (1.47 days vs. 2.08 days, p = 0.001).
Conclusion: Study revealed that the low-pressure pneumoperitoneum observed to be the
feasible and safe alternative to standard pressure pneumoperitoneum, with certain
potential benefits including reduced operative time, lower postoperative pain, and shorter
hospital stays, while maintaining safety with no significant impact on liver enzyme
levels.

Key words: Laparoscopic cholecystectomy, low pressure pneumoperitoneum, Pain, Optative time, Hepatic enzyme.