Effect of active gas suctioning in postoperative pain after laparoscopic cholecystectomy

Abstract

Introduction: Abdominal pain and shoulder pain after laparoscopic cholecystectomy (LC) is most likely a combination of direct stretching of the diaphragm caused by insufflation and the release of hydrogen ions. Reducing postoperative discomfort after LC is an area of active research. Many methods such as low pressure pneumoperitoneum and intraperitoneal instillation of drugs (local anesthetic, saline) to reduce pain have been carried out. Drainage of gas after elective LC reduces early postoperative abdominal pain including shoulder pain. Materials and Methods: Seventy-five adult female patients with symptomatic gall stones were worked up on the outpatient department basis. After detailed history and physical examination, patient underwent elective surgery. After elective laparoscopic cholecystectomy, active suction was performed by inserting the laparoscopic suction irrigation device through a 5-mm trocar. Continuous suction will be applied for 60 s. In all the patients, port sites were closed in the standard manner. Postoperative pain, residual gas volume, and analgesic requirement were assessed and analyzed. Results: The median patient age was 32 years, median duration of surgery being 40 min. Residual gas volume (gas under diaphragm) was present in 22 patients out of 75 patients which accounts for 29.3% of the study population. The median amount of residual gas calculated using the formula was 7.3 ml (4.9–16.10 ml). Out of 75 patients studied, about eight patients developed shoulder pain and the rest of the patients complained of abdominal pain. Out of 75 patients studied, one patient developed gall bladder fossa collection. Conclusion: Active gas suction is a very simple procedure that is safe and feasible. Performing this procedure significantly decreases the residual intraperitoneal gas volume and postoperative pain after laparoscopic surgery and our surgeons should pay more attention in active aspiration of carbon dioxide at the end of laparoscopic operation.