Thodety Sanjay, Karan Agarwal, Prajawalam A Rathod
{"title":"低压与常压腹腔镜胆囊切除术及其对术中参数和术后疼痛的影响：一项观察性研究。","authors":"Thodety Sanjay, Karan Agarwal, Prajawalam A Rathod","doi":"10.71480/nmj.v66i2.768","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Pneumoperitoneum, created by insufflating carbon dioxide (CO<sub>2</sub>), 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.</p><p><strong>Methodology: </strong>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, CO<sub>2</sub> consumption, postoperative pain, and hospital stay were recorded. Statistical analysis was performed using SPSS version 16.0, with p<0.05 considered significant.</p><p><strong>Results: </strong>The study found no significant difference in operative duration between LPP and SPP groups. However, CO<sub>2</sub> 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.</p><p><strong>Conclusion: </strong>Low-pressure pneumoperitoneum in laparoscopic cholecystectomy is associated with reduced CO<sub>2</sub> 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.</p>","PeriodicalId":94346,"journal":{"name":"Nigerian medical journal : journal of the Nigeria Medical Association","volume":"66 2","pages":"715-723"},"PeriodicalIF":0.0000,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12280292/pdf/","citationCount":"0","resultStr":"{\"title\":\"Low-Pressure Versus Normal-Pressure Laparoscopic Cholecystectomy and its Effect on Intra-Operative Parameters and Post-Operative Pain: An Observational Study.\",\"authors\":\"Thodety Sanjay, Karan Agarwal, Prajawalam A Rathod\",\"doi\":\"10.71480/nmj.v66i2.768\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Pneumoperitoneum, created by insufflating carbon dioxide (CO<sub>2</sub>), 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.</p><p><strong>Methodology: </strong>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, CO<sub>2</sub> consumption, postoperative pain, and hospital stay were recorded. Statistical analysis was performed using SPSS version 16.0, with p<0.05 considered significant.</p><p><strong>Results: </strong>The study found no significant difference in operative duration between LPP and SPP groups. However, CO<sub>2</sub> 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.</p><p><strong>Conclusion: </strong>Low-pressure pneumoperitoneum in laparoscopic cholecystectomy is associated with reduced CO<sub>2</sub> 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.</p>\",\"PeriodicalId\":94346,\"journal\":{\"name\":\"Nigerian medical journal : journal of the Nigeria Medical Association\",\"volume\":\"66 2\",\"pages\":\"715-723\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-06-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12280292/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Nigerian medical journal : journal of the Nigeria Medical Association\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.71480/nmj.v66i2.768\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nigerian medical journal : journal of the Nigeria Medical Association","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.71480/nmj.v66i2.768","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
Low-Pressure Versus Normal-Pressure Laparoscopic Cholecystectomy and its Effect on Intra-Operative Parameters and Post-Operative Pain: An Observational Study.
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.
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