Low-Pressure Versus Normal-Pressure Laparoscopic Cholecystectomy and its Effect on Intra-Operative Parameters and Post-Operative Pain: An Observational Study.

Abstract

Background: Pneumoperitoneum, created by insufflating carbon dioxide (CO₂), is essential for surgical visualization, but conventional intra-abdominal pressures (12-15 mmHg) can negatively impact cardiac and respiratory functions. To mitigate these effects, low-pressure pneumoperitoneum (7-10 mmHg) has been suggested. The present study aimed to compare the outcomes of laparoscopic cholecystectomy at low intra-abdominal pressure with conventional standard pressure laparoscopic cholecystectomy.

Methodology: A prospective observational study was conducted in a tertiary care hospital in Eastern India over a period of one year, involving 100 patients undergoing elective LC for symptomatic uncomplicated cholelithiasis. Participants were divided into two groups: low-pressure pneumoperitoneum (LPP) (7-10 mmHg) and standard-pressure pneumoperitoneum (SPP) (12-15 mmHg). Key parameters such as operative time, hemodynamic changes, CO₂ consumption, postoperative pain, and hospital stay were recorded. Statistical analysis was performed using SPSS version 16.0, with p<0.05 considered significant.

Results: The study found no significant difference in operative duration between LPP and SPP groups. However, CO₂ consumption was significantly lower in the LPP group (p=0.040). Postoperative shoulder tip pain was more frequent in the SPP group (p=0.041). Additionally, patients in the LPP group had a significantly shorter hospital stay (p=0.042). Hemodynamic changes, particularly in heart rate and systolic blood pressure, were less pronounced in the LPP group compared to the SPP group.

Conclusion: Low-pressure pneumoperitoneum in laparoscopic cholecystectomy is associated with reduced CO₂ consumption, less postoperative pain, better preservation of hemodynamics, and shorter hospital stays compared to standard-pressure pneumoperitoneum. Despite potential challenges for surgeons, LPP appears to be a safe and feasible alternative for uncomplicated gallstone surgery in the hands of skilled professionals.